Abstract
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is a significant risk factor for Stroke. AF is even more prevalent among patients with respiratory disease; it is therefore important that we anticoagulate this group of patients when indicated. The National Institute for Health and Care Excellence (NICE) provides guidance on Stroke prevention in non valvular AF (CG 180).
The Aim of this Audit was to improve our current anticoagulation practice in patients with respiratory disease and co-existing AF.
The objectives were to Identify respiratory patients with non-valvular AF. In those already anti-coagulated, we aimed identify which anticoagulant was in use. In appropriate patients not previously anticoagulated and new paroxysmal AF patients, we determined whether the patient was anti-coagulated by the respiratory firm.
Data was collected directly from patient casenotes on two respiratory wards in November 2015 and February 2016. There were 24 patients with included in the first round of data collection, and 26 in the second.
Anticoagulation coverage of patients with non-valvular AF was intitally poor (20%). Furthermore, documentation with regards to anticoagulation decisions was lacking (10%). With increased awareness (ward posters) and the implementation of an ECG review system on patient arrival to the ward, coverage of suitable AF patients with anticoagulation has improved (90% vs 20%), as has decision documentation (75% vs 10%). A further result of the audit has been clarification of the management of 'First AF', often a source of confusion for the non-cardiologist. This definition we aim to include in an updated version of the trust guidelines.
- Copyright ©the authors 2016
