075Atrial Fibrillation and Stroke Prevention: An Audit of Anticoagulation Use and Monitoring

Abstract

Background: Prevalence of atrial fibrillation (AF) increases with age with almost 10% of people over 80 affected. It is one of the most significant risk factors for ischaemic stroke; however, proper treatment reduces this risk by up to two thirds. Our aim is to determine whether anticoagulation prescribing in patients presenting to our hospital with a known diagnosis of AF is in line with the NICE guidelines and whether these patients are receiving appropriate follow up. Methods: 50 inpatients with a documented history of AF were selected randomly for inclusion in the audit. Patients newly diagnosed with AF on admission were excluded. Their CHADsVASc &HASBLED scores were calculated. Anticoagulation (OAC) on admission was recorded. Recent INRs, time in therapeutic range (TTR) and U&E monitoring was checked using the hospital lab system. Results: The mean age was 81.6. Mean CHADsVASc was 4 (range 2 - 6) and HASBLED was 2 (range 1 - 4). 32% of patients were on aspirin, despite all having CHADsVASc scores of 2 or above. High falls risk was the most common reason cited for a patient not to be on OAC (43.75%). 40% of patients were anticoagulated with warfarin and 28% were on a direct oral anticoagulant (DOAC). TTR for those attending the warfarin clinic was 62% as compared to 38% for those attending their GP. 64% of patients on a DOAC did not have a U&E check in the last 6 months, and 43% of these were dosed inappropriately given the patients renal function. Conclusions: Despite clear guidelines, a large number of patients remain underanticoagulated or on improper doses of OACs. Following this audit, we intend to survey GPs on their prescribing practices, provide educational sessions, and outline a clear follow up pathway for patients on OACs upon hospital discharge.