A quality study to improve prophylactic antithrombotic therapy prescribed to patients with atrial fibrillation.
BACKGROUND
Atrial fibrillation is the most common cardiac arrhythmia and has important clinical repercussions, increasing thromboembolic events and mortality. The CHA2DS2-VASc and HAS-BLED scores assist the clinician in assessing the benefits and risks of antithrombotic therapy.


OBJECTIVE
The aim of this study was to assess and improve the quality of prophylactic antithrombotic therapy prescribed to patients with atrial fibrillation.


METHODS
This was a quality study, based on a cycle of assessment and improvement, applied to the population of a family health unit, consisting of an initial assessment, an educational intervention and a second assessment. Both scores were calculated for all patients. Whenever the CHA2DS2-VASc score recommended initiation of anticoagulation, the risk was calculated by the HAS-BLED score; it was thus possible to determine for each patient if the prescribed therapy was appropriate.


RESULTS
The first assessment included 105 patients, of whom 49.5% had appropriate prophylactic therapy according to their scores. In the second assessment, four months after the educational intervention, 60.0% had been prescribed appropriate therapy, which represented a 21.2% improvement.


CONCLUSIONS
In both assessments, inappropriate treatment was due to non-prescription of prophylactic oral anticoagulation. This quality cycle serves as a tool for continuous assessment in the pursuit of improved care for patients with atrial fibrillation.
USF Infante D. Henrique, Viseu, Portugal. Electronic address: rui_joveira@yahoo.com.
Rui
R
Oliveira
USF Infante D. Henrique, Viseu, Portugal.
Sandra
S
Grilo
USF Infante D. Henrique, Viseu, Portugal.
Carla
C
Moreira
USF Infante D. Henrique, Viseu, Portugal.
Jorge
J
Santos
UCSP D. Duarte, Viseu, Portugal.
Rodolfo
R
Feitor
USF Infante D. Henrique, Viseu, Portugal.
Raquel
R
Moreira
USF Infante D. Henrique, Viseu, Portugal.
Martina
M
Rocha
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D058996:Quality Improvement; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D005343:Fibrinolytic Agents
Atrial fibrillation; Bleeding risk score; CHA2DS2-VASc; Estratificação do risco tromboembólico; Fibrilhação auricular; Score de risco hemorrágico; Thromboembolic risk stratification