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Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice

Journal of Thrombosis and Thrombolysis volume 24, pages 65–72 (2007)Cite this article

Abstract

Background

Atrial fibrillation (AF) is the most common heart arrhythmia, affecting 6% of people over 65 years, and carries a 4.5% average annual stroke risk, which can be reduced by appropriate anticoagulation. A multi-centre observational study, Management and Outcomes in the Care of Atrial fibrillation in Germany (MOCA) was conducted to evaluate the current anticoagulation treatment pattern in patients with AF in Germany.

Methods

Patients with AF were recruited from December 2003 to June 2004 in physician practices. Clinical data including International Normalised Ratio (INR) values and anticoagulation strategy were obtained from the physician chart and the patient follow-up, documenting hospitalisations, medications, and complications, was conducted at three and six months. Main outcome measures included anticoagulation methods, practice guidelines adherence and time within recommended anticoagulation range.

Results

361 patients with AF (mean age 71±9, 61% male) were recruited in 45 physician practices. 90% of all patients had been treated with Vitamin K-Antagonists (VKA) at some time since AF-diagnosis, 88% were still treated. 10% of patients received aspirin as their anticoagulation therapy. Monitoring occurred at least once a month in over 70% of patients. Monitored INR values were 56% of the time within, 14% below and 30% over the recommended target range. A gap of 40% existed between the guideline recommendations and actual practice. Younger patients (<60 years of age) with no documented risk factors for stroke were over-treated with VKAs and patients older than 75 years without contraindications for anticoagulation were under-treated.

Conclusions

This study presents ‘real-life’ data in treating patients with AF in Germany and identifies the potential to advance the quality of care with respect to anticoagulation.

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Acknowledgments

Many thanks to Annette Wagner for organization of the study office, Birgit Frank and Anna Mattenklotz for data collection and Ulrike Stasun for data management. Funding for this study was granted from AstraZeneca GmbH, Tinsdaler Weg 183, 22880 Wedel, Germany.

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Authors and Affiliations

  1. Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, 10098, Berlin, Germany

    Doreen McBride, Bernd Brüggenjürgen, Stephanie Roll & Stefan N. Willich

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  1. Doreen McBride
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  2. Bernd Brüggenjürgen
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Correspondence to Doreen McBride.

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McBride, D., Brüggenjürgen, B., Roll, S. et al. Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice. J Thromb Thrombolysis 24, 65–72 (2007). https://doi.org/10.1007/s11239-006-0002-8

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  • DOI: https://doi.org/10.1007/s11239-006-0002-8

Keywords

  • Atrial fibrillation
  • Anticoagulation
  • Clinical practice patterns
  • Stroke
  • Practice guidelines