Authors (including presenting author) :
Chan PF, Lai KPL, Chan WY, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster (KEC)
Introduction :
AF is the commonest cardiac arrhythmia which increases the risk of stroke by 5-fold. Oral anticoagulation (OAC) with vitamin K antagonists (VKAs) or NOACs markedly reduces the stroke risk and mortality in AF patients. Most updated international guidelines recommended the use of NOACs over warfarin for prevention of thromboembolic stroke in NOAC-eligible patients with AF because NOACs offer better efficacy, safety, and convenience.
Objectives :
1. To set up a pilot AFC in a GOPC in KEC. 2. To review the outcomes of the patients managed in the AFC.
Methodology :
Updated clinical guideline and consultation templates were prepared to aid doctors to manage AF patients including the use of NOACs. All 4 available NOACs were introduced in the AFC so that the most suitable NOAC could be selected according to patient’s clinical conditions. Electronic calculators for calculating CHA2DS2-VASc score, HAS-BLED score and CrCl by Cockcroft-Gault equation were added to our Department website. The clinical information of patients attended the AFC from 1st May 2019 to 30th November 2019 were reviewed and analysed.
Result & Outcome :
54 patients (57.4% were female patients, mean age was 76.9 years) attended the AFC during the review period. The mean duration of AF was 4.9 years. 38.9% of patients had history of cerebrovascular disease. 38 (70.4%) patients were put on NOACs by physicians in secondary care. After attending the AFC, 88.9% of patients were put on NOACs (10 patients were newly started on NOACs as free drugs, 23 patients had their NOACs changed from self-financed items to free drugs and 15 patients were put on NOACs as self-financed items according to HADF prescription criteria). NOACs were clinically not suitable for 2 patients and were refused by 4 patients. 14, 15, 12 and 7 patients were prescribed with dabigatran, rivaroxaban, apixaban and edoxaban correspondingly. No patients encountered serious adverse effects or developed stroke during the follow-up period. In conclusion, NOACs can be safely used in primary care and the introduction of NOACs in GOPCs can help to reduce the stroke risk of patients with AF and hence the burden in secondary care.
