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ACTIONABLE ATRIAL FIBRILLATION: WHEN DO I GET MY OAC?
Abstracts
QOL assessment reported by patients and clinicians. We sought to understand whether patient and clinician reported QOL assessments can be used interchangeably by examining the relationship between the Atrial Fibrillation Effect on QualiTyof-Life (AFEQT) questionnaire and the Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale. METHODS: Using a large provincial AF clinic registry database at Cardiac Services BC, we retrospectively analyzed AF patients between January 2009 and August 2016. The study cohort included all patients who completed the AFEQT questionnaire at clinic intake and had SAF data. Patient-reported QOL assessment was evaluated using the AFEQT questionnaire, which is a seven point Likert-type response scale containing 4 domains: symptoms (4 items), daily activities (8 items) and treatment concerns (6 items), and treatment satisfaction (2 items), and a summary score that includes the first 3 domains. Clinician-reported QOL assessment was evaluated using the SAF scale, which is a widely-used clinician-reported scoring system that range from class 0 (asymptomatic) to 4 (severe impact of symptoms on quality of life and activities of daily living). To examine the relationship between the AFEQT questionnaire and the SAF scale, we calculated Spearman’s correlation coefficients (r). RESULTS: A total of 7,287 AF patients were included. Mean age was 66 13 with 60% men and 65% had CHADS2 score 1. There was a significant negative linear relationship between the SAF class and sub-domains of the AFEQT questionnaire and the overall score (Symptoms: r¼-0.397, Daily activities: r¼-0.369, Treatment concerns: r¼-0.295, Treatment satisfaction: r¼0.361, and Overall score: r¼-0.412, all p < 0.001). However, the extent of this relationship differed between sub-domains with the strongest correlation in the symptoms domain and the weakest in the treatment concerns domain. CONCLUSION: Patient and clinician views on QOL are not necessarily interchangeable and may differ depending on the sub-domains assessed. This study suggests that the AFEQT questionnaire may be used to identify more specific targets of intervention (including fear, anxiety, and uncertainty about the effects of triggering AF) that are not fully captured in the SAF scale. The AFEQT questionnaire is a useful clinical tool for providing complementary information as part of a comprehensive assessment in the management of AF and to enhance patient-centered care.
S61
104 ACTIONABLE ATRIAL FIBRILLATION: WHEN DO I GET MY OAC? J Scott-Herridge, R Steigerwald, G Drobot, C Seifer, W McIntyre Winnipeg, Manitoba
Atrial fibrillation (AF) is the most common heart dysrhythmia. AF is associated with an increase in the risk of ischemic stroke and this risk can be decreased by 2/3 with initiation of oral anticoagulation (OAC). AF is commonly diagnosed in the Emergency Department (ED) and we have previously suggested that ED Physicians (EDPs) play an important role in initiating OAC. METHODS: Among patients with actionable AF (new or known AF in a patient who has an indication for OAC but is not taking it) who visit the ED, we sought to assess the impact of the speciality of the decision-making physician on the likelihood of receiving guideline-recommended therapy within 90 days of the ED visit. We also examined the impact of the prescribing physician on persistence of therapy at 6 months. This is a multi-hospital, retrospective cohort study of all patients who visited the ED of either a community, tertiary non-cardiac or tertiary cardiac hospital between September 1st, 2014 and May 30th, 2015 and had a discharge diagnosis of AF. Electronic and paper charts were examined to identify clinical characteristics, referral and prescription data. Patients were classified as either receiving a prescription from the EDP, referred to a specialist or assumed PCP (primary care provider) follow-up (in those with a registered PCP). Predictors of Canadian Cardiovascular Society (CCS) guideline-recommended anticoagulation at 90 days were analyzed using a multivariable logistic regression, adjusted for stroke and bleeding risk and new AF diagnosis. RESULTS: 788 patients were seen in the ED for AF. A total of 257 patients had actionable AF, 41% of which were new diagnoses. Mean CHADS2 score was 2+1. OAC prescription by the EDP independently predicted the likelihood of OAC fill within 90 days (OR 8.22, 95% CI 2.87-23.52, P < 0.001). Neither referral to a specialist nor PCP follow-up was associated with OAC initiation at 90 days. There was no difference in persistence of OAC in 6 months in patients receiving a prescription from the EDP as compared to patients receiving OAC from other physicians (74% versus 85%, respectively, P¼0.36). CONCLUSION: Many patients attending the ED are diagnosed with actionable AF. An OAC prescription written by an EDP was predictive of filling a prescription within 90 days but the same was not true for patients with PCP follow-up or specialist referral. Rates of persistence of therapy for prescriptions initiated by the ERP are similar to those initiated by other physicians. BACKGROUND:
QOL assessment reported by patients and clinicians. We sought to understand whether patient and clinician reported QOL assessments can be used interchangeably by examining the relationship between the Atrial Fibrillation Effect on QualiTyof-Life (AFEQT) questionnaire and the Canadian Cardiovascular Society Severity in Atrial Fibrillation (SAF) scale. METHODS: Using a large provincial AF clinic registry database at Cardiac Services BC, we retrospectively analyzed AF patients between January 2009 and August 2016. The study cohort included all patients who completed the AFEQT questionnaire at clinic intake and had SAF data. Patient-reported QOL assessment was evaluated using the AFEQT questionnaire, which is a seven point Likert-type response scale containing 4 domains: symptoms (4 items), daily activities (8 items) and treatment concerns (6 items), and treatment satisfaction (2 items), and a summary score that includes the first 3 domains. Clinician-reported QOL assessment was evaluated using the SAF scale, which is a widely-used clinician-reported scoring system that range from class 0 (asymptomatic) to 4 (severe impact of symptoms on quality of life and activities of daily living). To examine the relationship between the AFEQT questionnaire and the SAF scale, we calculated Spearman’s correlation coefficients (r). RESULTS: A total of 7,287 AF patients were included. Mean age was 66 13 with 60% men and 65% had CHADS2 score 1. There was a significant negative linear relationship between the SAF class and sub-domains of the AFEQT questionnaire and the overall score (Symptoms: r¼-0.397, Daily activities: r¼-0.369, Treatment concerns: r¼-0.295, Treatment satisfaction: r¼0.361, and Overall score: r¼-0.412, all p < 0.001). However, the extent of this relationship differed between sub-domains with the strongest correlation in the symptoms domain and the weakest in the treatment concerns domain. CONCLUSION: Patient and clinician views on QOL are not necessarily interchangeable and may differ depending on the sub-domains assessed. This study suggests that the AFEQT questionnaire may be used to identify more specific targets of intervention (including fear, anxiety, and uncertainty about the effects of triggering AF) that are not fully captured in the SAF scale. The AFEQT questionnaire is a useful clinical tool for providing complementary information as part of a comprehensive assessment in the management of AF and to enhance patient-centered care.
S61
104 ACTIONABLE ATRIAL FIBRILLATION: WHEN DO I GET MY OAC? J Scott-Herridge, R Steigerwald, G Drobot, C Seifer, W McIntyre Winnipeg, Manitoba
Atrial fibrillation (AF) is the most common heart dysrhythmia. AF is associated with an increase in the risk of ischemic stroke and this risk can be decreased by 2/3 with initiation of oral anticoagulation (OAC). AF is commonly diagnosed in the Emergency Department (ED) and we have previously suggested that ED Physicians (EDPs) play an important role in initiating OAC. METHODS: Among patients with actionable AF (new or known AF in a patient who has an indication for OAC but is not taking it) who visit the ED, we sought to assess the impact of the speciality of the decision-making physician on the likelihood of receiving guideline-recommended therapy within 90 days of the ED visit. We also examined the impact of the prescribing physician on persistence of therapy at 6 months. This is a multi-hospital, retrospective cohort study of all patients who visited the ED of either a community, tertiary non-cardiac or tertiary cardiac hospital between September 1st, 2014 and May 30th, 2015 and had a discharge diagnosis of AF. Electronic and paper charts were examined to identify clinical characteristics, referral and prescription data. Patients were classified as either receiving a prescription from the EDP, referred to a specialist or assumed PCP (primary care provider) follow-up (in those with a registered PCP). Predictors of Canadian Cardiovascular Society (CCS) guideline-recommended anticoagulation at 90 days were analyzed using a multivariable logistic regression, adjusted for stroke and bleeding risk and new AF diagnosis. RESULTS: 788 patients were seen in the ED for AF. A total of 257 patients had actionable AF, 41% of which were new diagnoses. Mean CHADS2 score was 2+1. OAC prescription by the EDP independently predicted the likelihood of OAC fill within 90 days (OR 8.22, 95% CI 2.87-23.52, P < 0.001). Neither referral to a specialist nor PCP follow-up was associated with OAC initiation at 90 days. There was no difference in persistence of OAC in 6 months in patients receiving a prescription from the EDP as compared to patients receiving OAC from other physicians (74% versus 85%, respectively, P¼0.36). CONCLUSION: Many patients attending the ED are diagnosed with actionable AF. An OAC prescription written by an EDP was predictive of filling a prescription within 90 days but the same was not true for patients with PCP follow-up or specialist referral. Rates of persistence of therapy for prescriptions initiated by the ERP are similar to those initiated by other physicians. BACKGROUND: