Hospital readmission for major bleeding or thromboembolic complications in patients with atrial fibrillation

Introduction: The Tasmanian Atrial Fibrillation (TAF) Study was established to provide ongoing Australian data on the clinical management and outcomes of people with atrial fibrillation (AF). The initial phase of the study involved the collection of retrospective data in the period prior to the introduction of the novel oral anticoagulants in Australia.

Aims: To examine the patient characteristics, antithrombotic prescribing patterns and rates of hospital readmission due to bleeding or thromboembolism (TE).

Methods: We reviewed the medical records of patients admitted to Tasmanian public hospitals between January 2011 and June 2012 with a diagnosis of AF. We documented risk factors for stroke, major bleeding and prescribed medication during the index (i.e. first) admission. Patients were followed for three months from the discharge date of their index admission to identify any subsequent readmissions due to bleeding or TE complications of AF.

Introduction; The Tasmanian Atrial Fibrillation (TAF) Study was established to provide ongoing Australian data on the clinical management and outcomes of people with atrial fibrillation (AF). The initial phase of the study involved the collection of retrospective data in the period prior to the introduction of the novel oral anticoagulants in Australia.

Aims: To examine the patient characteristics, antithrombotic prescribing patterns and rates of hospital readmission due to bleeding or thromboembolism (TE).

Methods: We reviewed the medical records of patients admitted to Tasmanian public hospitals between January 2011 and June 2012 with a diagnosis of AF. We documented risk factors for stroke, major bleeding and prescribed medication during the index (i.e. first) admission. Patients were followed for three months from the discharge date of their index admission to identify any subsequent readmissions due to bleeding or TE complications of AF.

Results: A total of 1469 of 2502 patients (≥ 18 years) with AF were eligible for inclusion. The mean ± SD age and CHADS2 score of the patients overall were 76 ± 12.3 years and 2.1 ± 1.3, respectively. According to guideline recommendations, 64.1% of patients had a CHADS2 score ≥2 and were eligible for anticoagulant therapy. An anticoagulant (or anticoagulant plus antiplatelet) was prescribed for 55.6% of these patients at discharge. Antiplatelet agents were prescribed in 34.5% of patients while 9.9% received no antithrombotic therapy. In contrast, 51.4% of those at low risk (score 0) were discharged on an anticoagulant. The rates of bleeding and TE-related readmissions within three months were 2.4% (95% CI 1.6-3.3%) and 1.3% (95% CI 0.7-1.9%) respectively.

Discussion: The rates of bleeding and TE are consistent with other ‘real-world’ study data, where higher rates of bleeding have been reported as compared to clinical trials data. Poor anticoagulation control after hospital initiation of warfarin and lack of guidelines adherence in prescribing antithrombotic therapy might have contributed partially to our findings. There still exists a gap between the evidence-based risk stratification and antithrombotic management patterns among hospitalised patients with AF in Tasmania.Results. A total of 1469 of 2502 patients (≥ 18 years) with AF were eligible for inclusion. The mean ± SD age and CHADS2 score of the patients overall were 76 ± 12.3 years and 2.1 ± 1.3, respectively. According to guideline recommendations, 64.1% of patients had a CHADS2 score ≥2 and were eligible for anticoagulant therapy. An anticoagulant (or anticoagulant plus antiplatelet) was prescribed for 55.6% of these patients at discharge. Antiplatelet agents were prescribed in 34.5% of patients while 9.9% received no antithrombotic therapy. In contrast, 51.4% of those at low risk (score 0) were discharged on an anticoagulant. The rates of bleeding and TE-related readmissions within three months were 2.4% (95% CI 1.6-3.3%) and 1.3% (95% CI 0.7-1.9%) respectively.

Discussion: The rates of bleeding and TE are consistent with other ‘real-world’ study data, where higher rates of bleeding have been reported as compared to clinical trials data. Poor anticoagulation control after hospital initiation of warfarin and lack of guidelines adherence in prescribing antithrombotic therapy might have contributed partially to our findings. There still exists a gap between the evidence-based risk stratification and antithrombotic management patterns among hospitalised patients with AF in Tasmania.