Adherence to anticoagulation guidelines for atrial fibrillation: a district general hospital survey

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia and a significant cause of hospital admission, morbidity and mortality. AF significantly increases the risk of embolic stroke, and anticoagulation with warfarin can reduce this risk by up to 61%. International guidelines recommend the use of warfarin for atrial fibrillation in patients considered at higher risk for stroke.
This prospective observational study evaluates current adherence to anticoagulation guidelines for patients with atrial fibrillation. It was carried out in a district general hospital in London on 93 patients with atrial fibrillation admitted via the emergency department over a four-month period.
Patients’ mean age was 77 years and the mean age of onset of AF was 75 years. Eighty-eight per cent of patients were > 75 years and/or had another risk factor for embolic stroke requiring warfarin therapy. Anticoagulation treatment did not adhere to guidelines in 56% of patients at the time of hospital admission. This proportion fell slightly to 52% at the time of hospital discharge. A total of 20% of patients were discharged on no anticoagulation at all.
The adherence to anticoagulation guidelines for patients with atrial fibrillation, who are at risk of embolic stroke, appears inadequate. Despite the evidence supporting oral anticoagulation, clinical practice seems resistant to change. The future may include patient self-monitoring and the use of oral direct thrombin inhibitors to improve stroke prophylaxis.