Predictors Of Adherence To Antithrombotic Therapy Guidelines For Stroke Prevention In Atrial Fibrillation: Results From The Registry Of Atrial Fibrillation To Investigate New Guidelines (Rafting)

Purpose: Adherence to antithrombotic therapy (AT) guidelines for stroke prevention in atrial fibrillation (AF) remains low. We sought to identify predictors for the lack of adherence in a large Greek AF cohort. Methods: The Registry of Atrial Fibrillation To Investigate New Guidelines (RAFTING) of the Hellenic Society of Cardiology is a countrywide prospective observational study of AF in Greece that enrolled 1127 patients with a diagnosis of AF during their admission in the Emergency Departments of 31 hospitals and followed them for 6 months. We analyzed the anticoagulation attitudes of treating physicians and their adherence to guidelines according to thromboembolic risk estimation by the CHADS2 score that was in use during the study period (2010), ie, antiplatelets or vitamin K antagonists (VKA) for CHADS2=1 and VKA for CHADS2≥2. Results: Evaluation of adherence to AT was possible in 697 patients without newly-diagnosed AF at baseline and in 875 at 6 months. At baseline, 54% were receiving VKA and 32% antiplatelets, with an overall adherence of 67%. In multivariate analysis, independent predictors of adherence were age (OR=0.97, p=0.001), AF type (paroxysmal vs persistent/permanent, OR=0.45, p<0.001), and specialty of attending physician (other vs cardiologist, OR=0.52, p=0.024). At 6 months, adherence to AT was present in 76% of patients in total and in 81% of those also evaluated at baseline (14% increase vs baseline, p<0.001); AF type (OR=0.64, p=0.045), and physician's specialty (OR=0.53, p=0.009) remained independent predictors of adherence. Conclusion: In this representative countrywide registry of AF, higher age, paroxysmal AF, and attending physician's specialty seem to represent important barriers to AT adherence in AF.