CONTEMPORARY PRACTICE PATTERNS IN AF: AN AUDIT OF 5 CANADIAN TERTIARY CARE CENTRES

In the past year, 3 practice guidelines have been published providing recommendations to clinicians in the management of atrial fibrillation (AF). A paucity of data is available to assess current AF practice patterns surrounding hospitalization (pre and post care). As such, we sought to assess the utilization of management strategies for patients admitted to hospital with AF, focusing on stroke prophylaxis and rate and rhythm control strategies in five Canadian tertiary care centers. This retrospective chart audit included patients having a discharge diagnosis of primary or secondary AF between April 1, 2009 and March 30, 2010. Interim analysis of 723 patients showed 48.3% were managed by cardiologists (either under the care of or through consultation), 27.3% were identified as a first episode AF and 45.6% were symptomatic at presentation. The mean age of the cohort was 76.0 ± 12.7 (SD) years, mean CHADS2 score was 2.29±1.4, and 42.3% were on appropriate stroke prophylaxis prior to admission as indicated in the ACCP guidelines (8th ed). While in hospital, use of a stroke scoring system was documented in 16.4% of patients (CHADS2 used in all but 1 patient) and a bleeding risk assessment was documented in 6.5% of patients. At discharge, 57.1% of patients were on the appropriate ACCP recommended stroke prophylaxis regimen. Of those discharged on warfarin, 32.5% were discharged to family medicine clinics and 3.8% to anticoagulant clinics. Prior to admission 73.0% were taking a rate-controlling drug (55.1% B-blocker, 23.4% calcium channel blocker (CCB), 12.5% digoxin, 7.3% were paced); while at discharge 82.2% were taking a rate controlling drug (65.0% B-blocker, 19.5% CCB,18.4% digoxin). The mean heart rate at discharge was 75.3±16.5 beats per minute. Prior to admission, 11.2% were taking an antiarrhythmic drug; (45.9% amiodarone, 28.4% sotalol, 21.0% a Class IC agent and 4.9% dronedarone). At discharge 16.6% of patients were prescribed a drug utilized as a rhythm control strategy. Of these, amiodarone was utilized in 53.3%, sotalol in 20.0%, Class IC agent in 14.2% and dronedarone in 9.2%. This audit of AF practices reveals scarce use of scoring systems to establish stroke and bleedingrisk. While stroke prophylaxis improved from admission to discharge, > 40% were still not prophylaxed in accordance with current guidelines. Rate controlling agents were used in the majority both at admission and discharge, while only a minority were prescribed antiarrhythmic agents.