Abstract 4348051: Adherence to Guideline-Directed Oral Anticoagulant Therapy in Patients with Atrial Fibrillation and Atrial Flutter Admitted in a Tertiary Private Hospital: A Retrospective Study

Background: Atrial fibrillation (AF) is associated with an increased risk of thromboembolism. Atrial Flutter (AFL) has s imilar risk factors as AF and many of these patients eventually develop AF. Both the American Heart Association and European Society of Cardiology guidelines recommend anticoagulation in AF and AFL patients at elevated thromboembolic risk to prevent ischemic stroke and systemic thromboembolism. The objective of this study is to determine the adherence to guideline-directed oral anticoagulation therapy and identify the factors for non-adherence to current guidelines. Methodology: This single-center, retrospective cross-sectional study included all adults admitted with a primary or secondary diagnosis of AF and AFL between July 1, 2024, and December 31, 2024, who enrolled in the hospital’s AF Registry. The CHA2DS2VASc and/or CHA2DS2VA and HASBLED scores were recalculated by the primary investigator to ensure accuracy of the scores. Use of anticoagulant or antiplatelet during admission were obtained from electronic medical records. Results: Among the 158 AF and AFL patients (50% male, median age 71 years, mean CHA2DS2VASc for males 3.8 and for females 4.4), 107 (67%) were started on appropriate anticoagulation according to guideline recommendations. Of the remaining 51 patients, only 5 (9.8%) had absolute contraindication to anticoagulants while over half of the patients were not given anticoagulants due to perceived high risk for bleeding (62.75%). A significantly higher proportion of patients with concomitant peripheral arterial disease, coronary artery disease and chronic kidney disease were not managed according to guidelines. Conclusion: Despite existing guidelines in the management of atrial fibrillation, only 7 out of 10 patients were managed according to guideline-directed oral anticoagulant therapy. The most common reason for withholding of oral anticoagulants was perceived high risk for bleeding (62.7%)