Abstract P192: The Gap Between Guidelines and Practice for the Total Cardiovascular Care of Atrial Fibrillation Patients in an Extended Study for Re-ly Patients Receiving Dabigatran
Notice bibliographique
Résumé
Background Most atrial fibrillation (AF) patients have coexisting cardiovascular pathologies that worsen prognosis and require management. Although anticoagulation has received significant attention in AF patients, there is scarce data on the quality of the total cardiovascular care for AF patients. Our aim was to explore the gap between guideline recommendations and the actual comprehensive cardiovascular care of a well anticoagulated clinical trial AF population. Methods At the end of RE-LY, a randomized trial of two dabigatran doses in patients with AF at high risk of stroke, patients were offered to continue the randomized double-blinded dabigatran dose in the extended RELY-ABLE study. Table 1 shows all treatment targets for the management of AF and its concomitant cardiovascular issues that were distilled from international guidelines. Audit of RE-LY and RELY-ABLE data was done to assess whether these targets were achieved in individual patients at RELY-ABLE baseline. Results Of the 12,091 patients who received dabigatran in RE-LY, 5,849 patients among 546 centers in 35 countries were enrolled in RELY-ABLE. Overall, the mean age is 73 ± 8 years, 35% female, 81% hypertension, 27% coronary artery disease, 18% heart failure and 22% diabetes. Table 1 shows for how many patients each treatment target was relevant, and in whom the target was achieved. For example, of 1,483 patients at with diabetes, 986 (66.5%) patients achieved the target and had an HbA1c value <7.0%, and 497 (33.5%) patients did not achieve the target. We identified a total of 23,868 relevant treatment targets, of which 5064 (21.2%) were not achieved. Conclusions We indentified many opportunities to improve the total cardiovascular care for AF patients who were already well anticoagulated and successfully completed RE-LY. RELY-ABLE is an ongoing cluster-randomized trial that will test if a multifaceted knowledge translation intervention can assist to close this gap and improve patient outcomes. RELY-ABLE baseline achievement of treatment targets Treatment target Relevant group (% of RELY-ABLE Achieving target (% of relevant group) Not achieving target (% of relevant group) Blood pressure <140mmHg (<130mmHg for diabetics) 4,785 (81.2%) 3,378 (70.6%) 1,407 (29.4%) HbA1c <7.0% in diabetics 1,483 (25.2%) 986 (66.5%) 497 (33.5%) LDL <70mg/dL with high risk (<100mg/dL with moderate risk) 2,873 (48.7%) 1,408 (49.0%) 1,65 (51.0%) Not smoking 5,895 (100%) 5,551 (94.1%) 345 (5.9%) Stop antiarrhythmic drug if no sinus rhythm in past year 1,083 (18.4%) 667 (61.6%) 416 (38.4%) Rate control in rest <100 bpm 2,553 (43.3%) 2,377 (93.1%) 177 (6.9%) Stop aspirin if no history of stroke/CAD 3,550 (60.2%) 3,153 (88.8%) 397 (11.2%) Prescribe beta blocker for heart failure 822 (9.9%) 620 (75.4%) 202 (14.6%) Prescribe ACEi/ARB for heart failure 822 (9.9%) 664 (80.8%) 158 (19.2%)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».