Atrial Fibrillation, Clinical Profile and Adherence to GuidelinesMukesh Kumar, Aamir Rashid, Shamim Iqbal, Imran Hafeez, Ajaz Lone, Khurshid Aslam.
Background: Even in developed countries suboptimal anticoagulation and low adherence to guidelines is frequently
observed in Atrial fibrillation (AF) patients. There is no data from our regional population and very scarce Indian data about
the utilization patterns and adherence to guidelines for stroke prevention in AF. Aims and Objectives: To characterize
clinical profile and assess adherence to guidelines in stroke prevention in AF in north Indian population. Material and Methods:
It was a single centre observational study. All patients presenting to outpatient department or admitted in cardiology
wards from May 2014 to April 2016 with AF were included. Detailed history, examination and relevant investigations
were carried out .CHADS2 score was used for risk stratifying and prescribing oral anticoagulants in nonvalvular AF. The
effectiveness of oral anticoagulant was assessed by INR. Result: Total of 446 patients were included. Mean age of our
patients was 60.83±16.86 years. 48% were males and 52% were females. Rheumatic heart disease was most common
(37.2%) ethology followed by hypertensive cardiovascular disease (18.2%). Mean CHADS2 score was 2.63±1.5 in non
valvular AF. Out of 446 patients, 409(92%) patients were found to have indication for prescription of OAC as per guidelines,
out of which only 290 (71%) patients actually received OAC. OAC prescription was significantly higher in valvular vs. non
valvular AF ( p=0.0001).The rates of OAC prescription in our patients in age group, ≤65, 66-75, >75 years were 84.4%,
65% and 60.2% respectively Out of 290 patients who were eligible for OAC ,only 102(25%) patients were optimally
anti-coagulated. Conclusion: Discordance between guidelines and practice was found regarding prescription of OACs
and maintenance of optimal anticoagulation for stroke prevention in our population. Optimal anticoagulation needs to be
emphasized on both patients as well as physicians to prevent strokes and achieve better outcomes.
Key words: Oral Anticoagulants, International normalized ratio, CHADS2 score, Valvular heart disease.