Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project
Bibliographic record
Abstract
Background: The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) guidelines 2014 recommends oral anticoagulation (OAC) for patients with CHADS2 ?1 or age ?65 years and non-vitamin K oral anticoagulants (NOAC)s as the preferred medications. We aimed to evaluate adherence to these guidelines by family group practices (FMG) in Quebec. Methods and results: We completed a cross-sectional evaluation at 15 FMGs. There were 431 patients with non-valvular AF: mean age of 77.3±10.4 years and 52.9% were females. CHADS2 and HAS-BLED were infrequently documented (47% and 7%, respectively). Most patients (93%) were appropriately anticoagulated (96% for both patients with CHADS2 ?1 and patients with age ?65 years). Sixty-five percent of patients were anticoagulated with warfarin, 28% with NOACs and 21% of patients received a combination of oral anticoagulant (OAC)s and aspirin. Every decade increase in age was associated with 49% increase in odds of adherence to the guidelines and 26% decrease in odds of NOACs’s use. Each point increase in HAS-BLED was associated with 51% decrease in odds of adherence to the guidelines and 36% decrease in odds of NOACS’s use. No patient with HAS-BLED of ?5 received NOAC. Heart failure was associated with a 61% decrease in odds of NOACS’s use. Conclusion: AF management by FMGs could be improved by 1) increasing NOACs uptake, 2) decreasing the combination of OAC with ASA and 3) increasing documentation of stroke and bleeding risks.
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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 | 0.007 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.001 | 0.003 |
| 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".