The effectiveness of atrial fibrillation special clinic on oral anticoagulant use for high risk atrial fibrillation patients managed in the community

BMC Primary Care

Research

To Fung Leung¹  Catherine Xiao Rui Chen²  Ka Man Lau²  Yim Chu Li² 

[1] Box Hill Superclinic, 810 Whitehorse Road, 3128, Box Hill, VIC, Australia;Department of Family Medicine and General Out-Patient Clinics, Kowloon Central Cluster of the Hospital Authority of Hong Kong, Kowloon, Hongkong;

关键词: Atrial fibrillation;    Oral anticoagulant;    Cardiovascular disease risk factor;    Primary care;   

DOI  :  10.1186/s12875-023-02004-w

 received in 2022-04-26, accepted in 2023-02-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundService gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.MethodQuasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.ResultsAmong the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.ConclusionAFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1