Abstract 4357628: Gaps in Stroke Risk Documentation for Veterans with Incident Atrial Fibrillation

Background: Documentation of atrial fibrillation (AF)-associated stroke risk with the CHA 2 DS 2 -VASc score is an AHA/ACC clinical performance measure for outpatient AF management. Patterns of stroke risk documentation for patients with incident AF are not well-characterized. Research Question: What are rates and predictors of CHA 2 DS 2 -VASc/CHADS 2 (CHADS) documentation for patients with incident AF across the Veterans Health Administration (VA)? Methods: We developed a text searching algorithm to assess clinical notes for CHADS documentation. We included patients with outpatient AF diagnoses from 1/2022-9/2023 with primary care or cardiology visits within 90 days. We assessed rates of CHADS documentation in primary care/cardiology notes. We identified predictors of documentation using a multivariable logistic regression model including patient age, sex, race/ethnicity, rurality, distance from care, comorbidities, number of visits, diagnosis year, telehealth use, cardiology care use, and facility random intercepts. Results: There were 36,924 patients with new AF with 80,585 visits at 125 VA medical centers. Average age was 74 with 2.9% female, 78% White, 12% Black/African American, and 36% rural/highly rural. Across medical centers, the median rate of CHADS documentation within 90 days was 14.6% (range 0-40.8%) (Figure 1). In the adjusted analysis, CHADS documentation was less likely for patients who were older [age 70-77 adjusted odds ratio (aOR) 0.86 (95% CI 0.80-0.92) and >77 aOR 0.75 (0.70-0.81) vs <70], Black/African American [aOR 0.84 (0.76-0.94) vs White], and rural or highly rural [aOR 0.91 (0.84, 0.99) and aOR 0.80 (0.66, 0.96) vs urban] and for those with certain comorbidities (chronic kidney disease, coronary artery disease, heart failure, and peripheral artery disease) and telehealth visits [aOR 0.89 (0.82, 0.95)]. Documentation was more likely for those with more visits, diagnosed in 2023 [aOR 1.15 (1.08, 1.23) vs 2022], and seen by cardiology [aOR 9.14 (8.50, 9.82)] (Figure 2). Conclusions: Though CHA 2 DS 2 -VASc documentation is a performance measure for AF management, we found low documentation rates in clinical notes with significant variation across VA medical centers. Documentation rates were lower for patients who were Black/African American, lived in rural areas, received telehealth care, and whose age/comorbidities resulted in higher scores. Interventions are needed to promote high quality AF care across patient groups and care modalities.