Cardiology specialists versus other specialty physicians in the quality of anticoagulant therapy management for nonvalvular atrial fibrillation (NVAF) patients: A retrospective observational study

Abstract Objective: Nonvalvular atrial fibrillation (NVAF) patients are increasingly being admitted in hospital and distributed both in the cardiology department and other departments. The perception and experience on anticoagulant therapy of clinical physicians are related to the quality of anticoagulation in NVAF patients. Our study aimed to explore the difference of anticoagulation quality between cardiology specialists and other specialty physicians. Methods: A retrospective investigation was conducted in a Chinese tertiary hospital to collect patients with NVAF who were classified in the cardiology specialists managed anticoagulation care group (CMAC) group or other specialty physicians’ managed anticoagulation care (OMAC) group according to admission departments. The primary outcomes included emergency visiting events, bleeding events and thrombotic events. The secondary outcomes were practice of thrombotic and bleeding risk assessment, qualified warfarin TTR, appropriate medication of DOACs, patients’ follow-up rate and doctors’ knowledge on anticoagulant therapy. Results: A total of 687 NVAF patients were enrolled, including 216 warfarin patients, 342 patients on rivaroxaban and 129 dabigatran patients. Between CMAC group and OMAC group: there was no difference in baseline characters; anticoagulation related emergency visiting event occurred 2.7% vs 9.4% (p=0.038) in warfarin subgroup; bleeding events occurred 4.5% vs 14.2% (p=0.015) in warfarin subgroup and 0.8% vs 14.3% (p=0.007) in dabigatran subgroup; thrombotic events incidence was not different in each anticoagulant subgroup (p>0.05); assessment of thrombotic risk or bleeding risk in each anticoagulant subgroup was apparently different (p=0.000); qualified TTR rate in warfarin subgroup was 36.4% vs 21.6% (p=0.011); appropriateness of rivaroxaban dosage was 28.1% vs 18.7% (p=0.019), appropriateness of dabigatran dosage was 54.5% vs 36.5%, (p=0.040); for follow-up of anticoagulation clinics the warfarin subgroup was 62.7% vs 48.1% (p=0.031), rivaroxaban subgroup was 58.4% vs 45.7%(p=0.019) and dabigatran subgroup was 71.2% vs 37.1 (p=0.000). Conclusion: The study identified that the anticoagulation quality for NVAF patients in the CMAC group is better than in the OMAC group. And compared with other specialty physicians, cardiology specialists are much more acquainted with anticoagulant therapy. It is necessary to establish a cardiology specialists integrated multidisciplinary team to carry out anticoagulation management for all NVAF inpatients, so as to improve the quality of anticoagulant therapy.