IMPROVEMENT IN QUALITY OF CARE FOR ATRIAL FIBRILLATION IN GET WITH THE GUIDELINES — ATRIAL FIBRILLATION (GWTG-AFIB)
Anne B. Curtis, M.D., University at Buffalo, Buffalo, NY, USA
Get With The Guidelines (GWTG) is a quality improvement program that has demonstrated improvement in the management of heart failure, myocardial infarction, and stroke. Recently, GWTG developed an atrial fibrillation (AF) module that has been adopted by 79 hospitals across the U.S. We sought to determine if participating in GWTG-AFIB would be associated with high rates of compliance with anticoagulation using the new ACCF/AHA AF performance measure definitions.
Methods: We included GWTG-AFIB patients with a primary or secondary diagnosis of AF at centers with >90% complete data. Patients with documented absolute contraindications to oral anticoagulation were described but not included in the primary analysis. Adherence to the ACCF/AHA performance measures for AF was reported and the adjusted association with adherence and outcomes was determined.
Results: The cohort included 20,342 AF admissions. The median age was 71, 48% were female, and the median CHA2DS2-VASc score was 4. The distribution of first-detected/paroxysmal/persistent/long-standing persistent AF was 27%/47%/15%/11%. Contraindications to oral anticoagulation were documented in 3678 patients (19%). Rates of oral anticoagulation at hospital discharge in eligible patients (no contraindications) with a CHA2DS2-VASc >2 was 92.3% in the total population. Rates of anticoagulation were similar by race and coronary artery disease status. However, anticoagulation was more frequent in men (p<.001), those with heart failure (p<.001), age <75 (p=0.007), prior AF ablation (p<.001), and rhythm control (p<.001). Utilization of oral anticoagulation at discharge in eligible patients improved to >90% after the 2nd year of the program and is now 95.6% in the last quarter of enrollment.
Conclusions: Among hospitals participating in GWTG-AFIB, use of stroke prevention therapy at discharge in eligible guideline-indicated patients was high and improved over time. This national practice quality improvement registry demonstrates that a high degree of adherence to stroke prevention and AF quality measures is achievable and sustainable.