title: Nonadherence to guidelines for prescribing antiplatelet/anticoagulant therapy in patients with atrial fibrillation.
abstract: We have found no papers evaluating nonadherence to guidelines for the treatment of atrial fibrillation (AF), taking into account the two risk scales [C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke (CHADS2) and C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke; V, vascular disease; A, age; Sc, sex category (CHA2DS2-VASc)] and the two types of treatment that are recommended (antiplatelet/anticoagulant therapy).
  
  
  
  To determine the extent of lack of adherence when prescribing anticoagulant and antiplatelet therapy to patients with AF and associated factors.
  
  
  
  Cross-sectional, observational study of 144 patients with AF who visited the emergency department of Elda Hospital in 2013-14 (Spain). Main variable: the patient was prescribed a therapy different from that indicated by the guidelines (nonadherence) or not prescribed any therapy. Secondary variables: CHADS2, CHA2DS2-VASc, HAS-BLED, type of AF and symptoms related to AF. Multivariate models were constructed to identify the associated factors by calculating the adjusted odds ratios (OR).
  
  
  
  Nonadherence occurred in 90 patients [62.5%, 95% confidence interval (CI): 54.6-70.4%]. Associated factors were higher CHADS2 (OR = 1.30, 95% CI: 0.96-1.75, P = 0.091) and CHA2DS2-VASc (OR = 1.23, 95% CI: 1.02-1.47, P = 0.027), and lower HAS-BLED (OR = 0.67, 95% CI: 0.49-0.91, P = 0.011).
  
  
  
  Nonadherence to guidelines was found in three out of every five patients. A greater cerebrovascular risk and a lower haemorrhagic risk were associated with this behaviour. Qualitative studies are needed to determine the causes.
authors.affiliation: Emergency Unit, Elda Hospital, Elda, Alicante.
authors.forename: Miguel
authors.initials: M
authors.lastname: Navarro-Juan
authors.affiliation: Emergency Unit, Elda Hospital, Elda, Alicante.
authors.forename: María Á
authors.initials: MÁ
authors.lastname: Carbonell-Torregrosa
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante and Research Unit, Elda Hospital, Elda, Alicante, Spain. antonio.pb23@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palazón-Bru
authors.affiliation: Emergency Unit, Elda Hospital, Elda, Alicante.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Martínez-Díaz
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante and Research Unit, Elda Hospital, Elda, Alicante, Spain.
authors.forename: Vicente F
authors.initials: VF
authors.lastname: Gil-Guillén
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D020521:Stroke / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; atrial fibrillation; physician’s practice patterns; platelet aggregation inhibitors; primary health care.