Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable: First Results From Get With The Guidelines–Atrial Fibrillation (GWTG-AFIB)

Background: Efforts to improve oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) have had limited success in improving guideline adherence. Methods:We evaluated adherence to the ACC/AHA performance measures for OAC in eligible patients with a CHA2DS2-VASc≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines (GWTG) AFIB registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33,235 AF admissions with a CHA2DS2-VASc≥2 enrolled at 115 sites between January 1, 2013 and September 31, 2017. Results:The median age was 73 (65, 81), 52% were female, and the median CHA2DS2-VASc score was 4 (3, 5). At admission 16,206 (59.5%) with a prior diagnosis of AF were on OAC and OAC at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (OR 0.38, 95% CI 0.24-0.59, p<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25,499/27,...