Leading towards Health for All
Creating Synergies between Public Health and Primary Care
Keywords: Atrial fibrillation, anticoagluants, follow-up.
Introduction:
Many people use Non-vitamin-K oral anticoagulants (NOAK) today such as apixaban (in Sweden sold under the name Eliquis) instead of warfarin. Mostly patients with atrial fibrillation (AF) use it for stroke prophylaxis. But how well do we follow-up patients as recommended by the Swedish National Board of Health and Welfare? The aim was to evaluate the need for improved care of patients with atrial fibrillation on anticoagulants.
Method:
A data system called MedRave, that automatically is updated with key indicators from patient records, during the last 18 months, such as diagnosis, medications, kidney function, and date for last visit, was used to extract information for further analysis.
Results:
181 patients out of approximately 10,000 patients listed at the health centre had the diagnosis atrial fibrillation, of these 94% was treated with anticoagulants (NOAK).
22 % of patients (30 people) had not been followed up with blood tests or visit to the general practitioner (GP) for over a year, of which half of patients was older than 80 years and 9 out of 10 patients suffered from comorbidity with at least two chronic diagnoses. In general, there was an inconsistency in recording of BP, ECG, and blood-tests in most patients with the diagnosis atrial fibrillation. 78% had their BP taken, 55% ECG, 45% BMI, 59% glucose-test, eGFR 83%, Hb 76%. Only 17% of AF patients had CHA2DS2-VASc Score recorded in their patient records.
Conclusions:
There is a need for improved recording of BP, BMI, blood-tests, CHA2DS2-VASc Score and bleeding anamnesis. It was agreed that patients 80+ of age, should be offered follow up twice a year, one visit to the nurse and one visit to the GP. CHA2DS2-VASc Score, should be recorded. Patients who had not been followed up properly duringhe last 12 months, were contacted immediately for a visit.
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