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We are pleased to introduce you to the quality improvement educational program Stroke Prevention in Atrial Fibrillation. Each year approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. Strokes are the leading cause of disability with over 500,000 patients living with its effects, and the third leading cause of death in Canada. They cost the Canadian economy at least $3.6 billion dollars annually.1 In keeping with the aging population demographics, the overall prevalence of atrial fibrillation (AF) and associated strokes is increasing every year.2
The 2020 Canadian Cardiovascular Society guidelines2 recommend treatment with oral anticoagulants of patients over 65 or with a CHADS2 >1 with atrial fibrillation (AF) to prevent stroke. So that all patients with AF are effectively treated and strokes prevented, it is critical that family physicians review the charts of all patients with AF in their practice so that guideline recommended oral anticoagulant treatment be initiated in those patients for whom it is not contraindicated.
In a national chart audit of 7,019 patients with nonvalvular atrial fibrillation from 735 Canadian primary care physician practices, >65% of patients who received no antithrombotic therapy in fact met the criteria for treatment with an oral anticoagulant (OAC). In addition, 62.8% of patients who were treated with acetylsalicylic acid monotherapy met guideline criteria for use of an OAC.3
This point-of-care quality improvement program is founded on current national to improve patient safety and outcomes, within a framework of patient-centered values and preferences.
Alan Bell, MD, CCFP, FCFP (Chair)
- Boulanger J, Lindsay M, Gubitz G, et al. Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. International Journal of Stroke. 2018;13(9):949-984.
- Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Canadian Journal of Cardiology. 2020;36(12):1847-1948.
- Bell AD, Gross P, Heffernan M, et al. Appropriate Use of Antithrombotic Medication in Canadian Patients With Nonvalvular Atrial Fibrillation. Am J Cardiol. 2016;117(7):1107-1111.
Program learning objectives
After completing all elements of this program, participants will be better able to:
Examine gaps in practice using electronic medical records (EMR) queries;
Identify specific patients with atrial fibrillation (AF) who would benefit from anticoagulation to prevent stroke;
Discuss the appropriate choice and dosing of anticoagulants for patients with AF to meet Canadian guideline-recommended anticoagulation standards.
The components of this program were developed and reviewed by a Steering Committee of experts from Thrombosis Canada. The committee consisted of the following medical practitioners:
|Alan Bell, MD, CCFP, FCFP (Chair) Family medicine
|Lauren Cameron, MD, CCFP, FCFP Family medicine
|Ania Bekasiak, MD Emergency medicine
|Sol Stern, BSc, MSc, MD, MFCP Family medicine