New Oral Anticoagulant Options for Stroke Prevention in Atrial Fibrillation = More Opportunities to Improve our Compliance with Evidence-based Care

American Heart Association: Thursday, Aug. 2, 2012

Atrial fibrillation (AF) is an important cause of stroke and the likely cause of ischemic stroke in 20% of men and 30% of women.¹  Cardiac embolism is more likely to result in a major cerebral vessel occlusion, hence the strokes associated with AF more commonly result in severe disability or death.²  Since 1985, thousands of patients with AF have participated in randomized clinical trials demonstrating the efficacy of antithrombotic therapy, most using warfarin, in preventing stroke.³  These data represent the most extensively studied of all stroke subtypes, so much so that they have generated several risk stratification scoring schemes, such as CHA2DS2VASc to further subset the subtype.⁴  Based on this persuasive data and the potential public health opportunity for the millions of individuals with AF, recommendations for oral anticoagulant therapy in appropriate patients with AF were incorporated into national and international guideline statements and identified as one of the first quality measures for improving stroke care.  Adopted by the AHA/ASA Get with the Guidelines-Stroke initiative in 2001, this quality measure has been endorsed by the Joint Commission in its Primary Stroke Certification, the Centers for Disease Control in its national Coverdell Stroke Registry, the National Quality Foundation, and CMS’ Pay-for Performance and the current Meaningful Use initiatives.  Read More