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
Bibliographic record
Abstract
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%)
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".