Real-World Cohort of Atrial Fibrillation Patients: Opportunity to Optimize Anticoagulant Therapy

Introduction: Stroke prevention with oral anticoagulants should be the default therapy in patients with atrial fibrillation (AF). We aimed to evaluate the implementation of relevant European Heart Society clinical practice guidelines implementation and define gaps in primary care population.

Methods: Clalit Health Fund (CHF) EHR were queried for patients with non-valvular atrial fibrillation (NVAF) in Tel Aviv, Sharon-Shomron and Southern Districts. NVAF patients were identified. Their demographics, components of CH₂ADS₂-VASC score and concomitant cardiovascular medications were collected.

Results: 39,053 NVAF patients were identified. Mean age 76.1±10.7 years, males 47.8%, mean BMI 28.3±5.4 kg/m². EF was available for only 20% of the patients (Mean EF -51.7±15.3). Oral anticoagulant treatment was prescribed to 69.7% of patients (Vitamin K antagonists and DOACs). Median CHADS₂ =2, Median CHA₂DS₂VASC =3.

Conclusions: About one third of eligible patients with NVAF are not prescribed guideline recommended therapy for stroke and systemic embolism prevention. Further efforts are needed to improve implementation of the guidelines.