Antithrombotic therapy in atrial fibrillation: an assessment of compliance with guidelines.

AIM: To assess physician compliance (at South Auckland's Middlemore Hospital) with two international guidelines on the prevention of thromboembolic complications of atrial fibrillation (AF). The two guidelines are The American College of Cardiology/American Heart Association/European Society of Cardiology consensus group (ACC/AHA/ESC guidelines-2001) and the American College of Chest Physicians guidelines (ACCP guidelines-2001).

METHOD: A retrospective review of patients who presented to the emergency department with AF between 1 December 2001 and 28 February 2002. Antithrombotic treatment was compared with that recommended by the above stated international guidelines. It was hypothesised that 20% variance from guideline recommended treatment was clinically significant. The incidence of stroke in the study group was followed over a 12-month period.

RESULTS: Eighty patients were included in the study. The proportion of patients managed in accordance with the ACC/AHA/ESC and ACCP guidelines was 47.5% (95% CI 36.2-59.0) and 31.2% (95% CI 21.3-42.6) respectively. This was significantly different from that hypothesised (p<0.0001). Only 47.4% (95% CI 34.0-61.0) and 47.3% (95% CI 33.6-61.2) of eligible patients, according to ACC/AHA/ESC and ACCP guidelines respectively, received warfarin. This was also less than hypothesised; p<0.0001. High-risk patients were less likely to be given warfarin if they were older (p<0.03). Four patients had a stroke at follow-up. These patients were not on warfarin, although recommended by the guidelines.

CONCLUSION: Warfarin is significantly underutilised in patients with AF at our institution.