Improving thromboprophylaxis using atrial fibrillation diagnostic capabilities in implantable cardioverter-defibrillators the multicentre italian ANGELS of AF project

Giuseppe Boriani, Massimo Santini, Maurizio Lunati, Maurizio Gasparini, Alessandro Proclemer, Maurizio Landolina, Luigi Padeletti, Giovanni Luca Botto, Alessandro Capucci, Stefano Bianchi, Mauro Biffi, Renato Pietro Ricci, Marco Vimercati, Andrea Grammatico, Gregory Y H Lip

Research output: Contribution to journalArticle

Abstract

Background-Atrial fibrillation (AF) is a well-established risk factor for stroke and thromboembolism and is a frequent comorbid arrhythmia in patients with implantable cardioverter-defibrillators (ICDs). The Anticoagulation Use Evaluation and Life Threatening Events Sentinels (ANGELS) of AF project was a medical care program aimed at supporting adherence to oral anticoagulation (OAC) guidelines for thromboprophylaxis through the use of ICD AF diagnostics. Methods and Results-Fifty Italian cardiology clinics followed 3438 patients with ICDs. In a subgroup of 15 centers (the ANGELS of AF centers), cardiologists attending to follow-up visits were supplied with specific reports describing stroke risk factors and risk scores (American College of Chest Physicians and CHADS2 [congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and prior stroke or transient ischemic attack]), AF occurrence and duration, and current antithrombotic therapy for patients with AF, especially those with a CHADS2 score > 0 and not on OAC therapy. The remaining centers represented a control group of patients as a comparison of OAC use. In the ANGELS of AF centers, 709 (36%) patients had AF described either in their clinical history (n=426 [22%]) or as new-onset AF (n=257 [14%]). Among 683 (96%) patients with CHADS2 score > 0, 209 (30.6%) were not taking an OAC. Appropriate OAC therapy was prescribed in 10% (22/209) of patients after evaluation of ANGELS of AF reports. The percentage of patients on OAC therapy, as indicated by guidelines, increased during follow-up from 46.1% at baseline, to 69.4% at the stroke risk evaluation phase, to up to 72.6% at the end of the observation period. In control centers, corresponding figures were 46.9% at baseline and 56.8% at the end of the observation period (P

Original languageEnglish
Pages (from-to)182-188
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume5
Issue number2
DOIs
Publication statusPublished - Mar 2012

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Keywords

  • Anticoagulants
  • Atrial fibrillation
  • Cerebral ischemia
  • Implantable cardioverter-defibrillators
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Boriani, G., Santini, M., Lunati, M., Gasparini, M., Proclemer, A., Landolina, M., Padeletti, L., Botto, G. L., Capucci, A., Bianchi, S., Biffi, M., Ricci, R. P., Vimercati, M., Grammatico, A., & Lip, G. Y. H. (2012). Improving thromboprophylaxis using atrial fibrillation diagnostic capabilities in implantable cardioverter-defibrillators the multicentre italian ANGELS of AF project. Circulation: Cardiovascular Quality and Outcomes, 5(2), 182-188. https://doi.org/10.1161/CIRCOUTCOMES.111.964205