title: Improving thromboprophylaxis using atrial fibrillation diagnostic capabilities in implantable cardioverter-defibrillators: the multicentre Italian ANGELS of AF Project.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a well-established risk factor for stroke and thromboembolism and is a frequent comorbid arrhythmia in patients with implantable cardioverter-defibrillators (ICDs). The Anticoagulation Use Evaluation and Life Threatening Events Sentinels (ANGELS) of AF project was a medical care program aimed at supporting adherence to oral anticoagulation (OAC) guidelines for thromboprophylaxis through the use of ICD AF diagnostics.
  
  
  RESULTS
  Fifty Italian cardiology clinics followed 3438 patients with ICDs. In a subgroup of 15 centers (the ANGELS of AF centers), cardiologists attending to follow-up visits were supplied with specific reports describing stroke risk factors and risk scores (American College of Chest Physicians and CHADS(2) [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack]), AF occurrence and duration, and current antithrombotic therapy for patients with AF, especially those with a CHADS(2) score >0 and not on OAC therapy. The remaining centers represented a control group of patients as a comparison of OAC use. In the ANGELS of AF centers, 709 (36%) patients had AF described either in their clinical history (n=426 [22%]) or as new-onset AF (n=257 [14%]). Among 683 (96%) patients with CHADS2 score >0, 209 (30.6%) were not taking an OAC. Appropriate OAC therapy was prescribed in 10% (22/209) of patients after evaluation of ANGELS of AF reports. The percentage of patients on OAC therapy, as indicated by guidelines, increased during follow-up from 46.1% at baseline, to 69.4% at the stroke risk evaluation phase, to up to 72.6% at the end of the observation period. In control centers, corresponding figures were 46.9% at baseline and 56.8% at the end of the observation period (P<0.001 versus ANGELS of AF group).
  
  
  CONCLUSIONS
  The ANGELS of AF project demonstrates the possibility to improve OAC use in accordance with available guidelines for stroke risk reduction in AF by supplying attending physicians with reports about patients risk factors and AF information from continuous ICD monitoring.
authors.affiliation: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S Orsola-Malpighi, Via Massarenti 9, Bologna, Italy. giuseppe.boriani@unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Stefano
authors.initials: S
authors.lastname: Bianchi
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Renato Pietro
authors.initials: RP
authors.lastname: Ricci
authors.forename: Marco
authors.initials: M
authors.lastname: Vimercati
authors.forename: Andrea
authors.initials: A
authors.lastname: Grammatico
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants