title: Atrial fibrillation anticoagulation care in a large urban family medicine practice.
abstract: OBJECTIVE
  To determine the proportion of patients with atrial fibrillation (AF) in primary care achieving guideline-concordant stroke prevention treatment based on both the previous (2010) and the updated (2012) Canadian guideline recommendations.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Primary care patients (N = 204) with AF. The mean age was 71.3 years and 53.4% were women.
  
  
  METHODS
  Large urban community family practice in Toronto, Ont.
  
  
  METHODS
  Patient demographic characteristics such as sex and age; a list of current cardiac medications including anticoagulants and antiplatelets; the total number of medications; relevant current and past medical history including presence of diabetes, stroke or transient ischemic attack, hypertension, and vascular disease; number of visits to the family physician and cardiologist in the past year and past 5 years, and how many of these were for AF; the number of visits to the emergency department or hospitalizations for AF, congestive heart failure, or stroke; if patients were taking warfarin, how often their international normalized ratios were recorded, and how many times they were in the reference range; CHADS2 (congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, and stroke or transient ischemic attack) score, if recorded; and reason for not taking oral anticoagulants when they should have been, if recorded.
  
  
  RESULTS
  Among those who had CHADS2 scores of 0, 64 patients (97.0%) were receiving appropriate stroke prevention in AF (SPAF) treatment according to the 2010 guidelines. When the 2012 guidelines were applied, 39 patients (59.1%) were receiving appropriate SPAF treatment (P < .001). For those with CHADS2 scores of 1, 88.4% of patients had appropriate SPAF treatment according to the 2010 guidelines, but only 55.1% were adequately treated according to the 2012 guidelines (P < .001). Of the patients at the highest risk (CHADS2 score > 1), 68.1% were adequately treated with anticoagulation and an additional 8.7% (6 of 69) had documented reasons why they were not taking anticoagulants.
  
  
  CONCLUSIONS
  When assessed using the 2012 Canadian Cardiovascular Society AF guidelines, the proportion of patients receiving appropriate SPAF therapy in this primary care setting decreased substantially. All patients with CHADS2 scores of 0 or 1 should be reassessed to ensure that they are receiving optimal stroke prevention treatment.
authors.affiliation: Taddle Creek Family Health Team, 790 Bay St, Suite 522, Box 58/59, Toronto, ON M5G 1N8. avalentinis@gmail.com.
authors.forename: Alissia
authors.initials: A
authors.lastname: Valentinis
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.forename: Sacha
authors.initials: S
authors.lastname: Bhatia
authors.forename: Nazanin
authors.initials: N
authors.lastname: Meshkat
authors.forename: Kori
authors.initials: K
authors.lastname: Leblanc
authors.forename: Andrew
authors.initials: A
authors.lastname: Ha
authors.forename: Dante
authors.initials: D
authors.lastname: Morra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D057286:Electronic Health Records; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014505:Urban Population
chemical_list: D000925:Anticoagulants