Atrial fibrillation
affects an estimated 5 million Americans and accounts for approximately
15% of all strokes. Few studies have successfully addressed patient
screening, assessment, and introduction of appropriate antithrombotic
therapy in patients with atrial fibrillation.
Objective: To assess whether an intervention improved planned
antithrombotic prescribing at the time of discharge in hospitalized
patients.
Methods: The study was a prospectively designed, retrospectively
evaluated, non-blinded, historical control study of a pharmacist-initiated
intervention. The intervention, consisting of pharmacist review
and assessment of antithrombotic prescribing in patients with
non-valvular atrial fibrillation, was conducted in an urban teaching
hospital.
Results: Although antithrombotic prescribing was not significantly
higher at discharge in the 252 enrolled subjects (control 67.3%
vs. intervention 70.8%; p = 0.58), a significantly greater number
of patients had a written discharge plan for antithrombotic therapy
(control 73.5% vs. intervention 88.3%; p < 0.01). The adjusted
odds ratio that the study group was associated with an improvement
in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74).
In addition, clinicians adhered to guidelines for antithrombotic
therapy in patients with atrial fibrillation more frequently in
the intervention group (control 70.4% vs. intervention 88.2%;
p < 0.01).
Conclusion: A program designed to identify hospitalized patients
with non-valvular atrial fibrillation, assess their need for stroke
prophylaxis, and initiate appropriate antithrombotic therapy led
to an increase in planned antithrombotic, and most importantly,
warfarin use upon discharge from the hospital. Confirmation that
an increase in planned antithrombotic use upon discharge results
in an actual increase in use after discharge is needed to determine
the true effectiveness of this intervention.
