Anticoagulation Therapy for Atrial Fibrillation/Flutter

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge

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Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.

The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke

Improvement noted as an increase in rate

Berge, E., Abdelnoor, M., Nakstad, P. H., et al. (2000, April 8). Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: A double-blind randomised study. Lancet, 355(9211), 1205-1210. 

Centers for Disease Control and Prevention. (2009, May 1). Prevalence and most common causes of disability among adults—United States, 2005. Morbidity and Mortality Weekly Report, 58(16), 421-426. 

Connolly, S. J., Ezekowitz, M. D., Yusuf, S., et al. (2009, September 17). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12), 1139-1151. 

Fuster, V., Ryden, L. E., Asinger, R. W., et al. (2001, October). ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation). Journal of the American College of Cardiology, 38(4), 1231-1266. 

Fuster, V., Ryden, L. E., Cannom, D. S., et al. (2006, August 15). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation). Circulation, 114(7), e257-354. 

Goldstein, L. B., Adams, R., Alberts, M. J., et al. (2006, June). Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, 37(6), 1583-1633. 

Gorelick, P. B., Sacco, R. L., Smith, D. B., et al. (1999, March). Prevention of a first stroke: A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA, 281(12), 1112-1120. 

Hart, R. G., Benavente, O., McBride R., et al. (1999, October 5). Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: A meta-analysis. Annals of Internal Medicine, 131(7), 492-501. 

Jauch, E. C., Saver, J. L., Adams, H. P., Jr., et al. (2013). Guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 44(3), 870-947. 

Kernan, W. N., Ovbiagele, B., Black, H. R., et al. (2014, May). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 45(7), 2160-2223. 

Lin, H. J., Wolf, P. A., Kelly-Hayes, M., et al. (1996, October). Stroke severity in atrial fibrillation: The Framingham Study. Stroke 27(10), 1760-1764

Penado, S., Cano, M., Acha, O., et al. (2003, February 15). Atrial fibrillation as a risk factor for stroke recurrence. American Journal of Medicine, 114,(3), 206-210. 

Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018, January). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 49, e31-e32. 

Roger, V. L., Go, A. S., Lloyd-Jones, D. M., et al. (2012, January 3). Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125(1), e2-e220. 

Saxena, R., & Koudstaal, P. J. (2011). Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack (review). Cochrane Database of Systematic Reviews, (4), CD000185. 

Saxena, R., Lewis, S., Berge, E., et al. (2001, October). Risk of early death and recurrent stroke and effect of heparin in 3,169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial. Stroke, 32(10), 2333-2337. 

Van Walraven, C., Hart, R. G., Singer, D. E., et al. (2002, November 20).Oral anticoagulants vs. aspirin in nonvalvular atrial fibrillation: An individual patient meta-analysis. JAMA, 288(19), 2441-2448. 

Wann, L. S., Curtis, A. B., Ellenbogen, K. A., et al. (2011, March 15). 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on dabigatran): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 57(11), 1330-1337. 

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The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.

The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.

TBD

Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during measurement period.

Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter.

Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations
Inpatient hospitalizations for patients discharged to another hospital
Inpatient hospitalizations for patients who left against medical advice
Inpatient hospitalizations for patients who expired
Inpatient hospitalizations for patients discharged to home for hospice care
Inpatient hospitalizations for patients discharged to a health care facility for hospice care
Inpatient hospitalizations for patients with comfort measures documented

Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge.

Not Applicable

Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Stroke (eSTK)