Rates of Oral Anticoagulant Use in Patients With Atrial Fibrillation Managed By Primary Care and Cardiology Providers With or Without Use of a Structured Note For Pinnacle Registry Reporting
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Oral anticoagulant (OAC) therapy is underutilized in patients with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2. However, the patterns of OAC selection, adherence with recommendations, and impact of structured note reporting among different specialties has not been well described.
As a part of an internal Quality Improvement initiative, records at Swedish Medical Center (Seattle, WA) from 2016 were reviewed. 10,928 patients had a diagnosis of AF. 3362 were seen by a Primary Care Provider (PCP) and not cardiology, 4439 were seen by cardiology and not a PCP, and 3127 seen by both PCP and cardiology. Rates of discrete reporting of the CHA2DS2-VASc score were noted and for those with a CHA2DS2-VASc score >2, overall use, and specific use of Direct Oral Anticoagulant (DOAC), warfarin, antiplatelet alone, or no therapy was tabulated. Individual provider data for the 8 cardiology providers routinely using the PINNACLE Note were tabulated, and also adjusted for why not given codes.
Of the overall PCP patients (N=6489), 1862 (29%) had a CHA2DS2-VASc score, and 1552 (24%) had a CHA2DS2-VASc score ≥2. Of the overall cardiology patients (N= 7566), 4261 (56%) had a CHA2DS2-Vasc score documented, and of those, 3517 (46%) had a CHA2DS2-Vasc score ≥2. Of the PCP patients with a CHA2DS2-Vasc of ≥2, 35% were treated with warfarin, 36% were treated with a DOAC, 29% with an antiplatelet, and 19% were not treated. Of the cardiology patients, 31% were treated with warfarin, 38% with DOAC, 27% with an antiplatelet, and 23% were not treated. Among the PINNACLE note providers, overall adherence with recommendations was 75%, but after adjusting for why not given codes, adherence was 95% (p <0.05).
CHA2DS2-Vasc scores are inconsistently documented by both PCP and cardiology providers. Among patients with documented CHA2DS2-Vasc scores of ≥2, 19% of PCP patients and 23% of cardiology patients did not have documented anticoagulation. DOAC use was more prevalent among cardiologists. Of the providers using the PINNACLE Note, following adjustment for why not given codes, documentation of adherence with guideline recommended treatment was 95%.
Center for Cardiovascular Analytics, Research + Data Science (CARDS)
Conference / Event Name
American College of Cardiology Annual Scientific Session & Expo
Book / Chapter Details
Journal of the American College of Cardiology
Volume 71, Issue 11 Supplement, March 2018
Petersen, John; Gluckman, Tyler J; Dale, Christopher; Buckler, Joshua; Wells, Darryl; Zhao, Lisa; Ingale, Sahana; and Westcott, R Jeffrey, "Rates of Oral Anticoagulant Use in Patients With Atrial Fibrillation Managed By Primary Care and Cardiology Providers With or Without Use of a Structured Note For Pinnacle Registry Reporting" (2018). Books, Presentations, Posters, Etc.. 92.