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Assessment of Guideline Recommended Anti-Coagulation Rates for Atrial Fibrillation in an Outpatient

Kanav Gupta

Oakland University William Beaumont School of Medicine


Introduction: Atrial fibrillation is one of the most common arrhythmias and can increase patients’ risk for embolic stroke. Current guidelines recommend utilizing the CHADS2VASc risk score to stratify patients based on their prior cardiovascular history and determine their annual stroke risk. If this value is greater than or equal to 2 then anticoagulation is recommended. The main objective is to assess the anticoagulation rates in patients with atrial fibrillation in the Beaumont Outpatient Internal Medicine Resident Clinic. Methods: In this retrospective study, all patients >18 years of age who had at least one encounter in the resident clinic over a five year period (Jan.2014 - Dec.2018) with the diagnosis of atrial fibrillation and not on anticoagulation had their CHADS2VASc score calculated. Results: 10,486 patients had an encounter in the clinics during our study period. 688 (6.6%) of our study population had a diagnosis of atrial fibrillation, of which 361 (52.5%) were not on anticoagulation. The results indicate that 290 out of 361 eligible patients, or roughly 80.3%, have a CHADS2VASc score of 2 or greater. Conclusion: Evidently, a significant portion of patients in the Beaumont Resident Clinic with a diagnosis of atrial fibrillation who are not on anticoagulation may qualify for it. This is much higher than the nationwide estimate of approximately 50% of patients who require anticoagulation and are not prescribed it. Using this data, we implemented an intervention to address this issue in our clinic.

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