Adherence to guidelines regarding anticoagulation and risk factors for progression of atrial fibrillation in a nurse-led clinic

Abstract

Background: Atrial fibrillation (AF) is the commonest cardiac arrhythmia associated with an increased risk of stroke. Evidence suggests that management in a specialty clinic improves clinical outcomes of patients. Aims: To assess level of adherence to evidence-based guidelines regarding anticoagulation and the risk factors for progression of AF in a nurse-led AF clinic. Methods: A retrospective analysis was conducted on clinical records of 136 patients seen at the AF clinic to determine their risk factors and progression of AF (change in AF type to more advanced types) during follow up. Additionally, the proportion of patients with CHA2DS2-VASC score (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, stroke (doubled)-vascular disease, age 65–74 years, sex category (female)) of ≥2 who were prescribed anticoagulants according to European Society of Cardiology guidelines before and after attending the clinic was determined. Results: Rate of anticoagulation in patients with CHA2DS2-VASC score of ≥2 after attending the clinic (91.3%) was significantly higher than the rate before attending the clinic (79.3%) (P = 0.0076). Mean age in those with AF progression (72.5 ± 9.4) was higher than those without AF progression (66.9 ± 13.9) (P = 0.0072). Rate of AF progression was higher in those with obesity (body mass index ≥30 kg/m2) (P = 0.0364) and those with excessive alcohol intake (>2 standard drinks) (P = 0.0039). History of hypertension was not a significant predictor of AF progression (P = 0.7507). Conclusions: Management of AF in a nurse-led clinic was associated with high level of adherence to anticoagulation guidelines. Age, obesity and excessive alcohol intake were significant predictors for progression of AF.