Improving Hospitalist Knowledge of Anticoagulation Therapy in Atrial Fibrillation

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia that affects 33.5 million people worldwide. AF is a $6 billion dollars economic burden and contributes to 700,000 hospital admissions annually to the United States. AF leads to the development of strokes and thrombo-embolic events. The risk of stroke increases five times with AF. Some 75% of these strokes lead to severe disability and death. These strokes are 68% preventable with anticoagulants. However, evidence indicates that anticoagulants are underused in 83% of AF patients. Provider education is would to improve anticoagulation usage in AF. Objective: This is a quality improvement project to provide CHA2DS2-VASc and HAS-BLED education to hospital providers. The purpose is to improving appropriate anticoagulation ordering in atrial fibrillation, increase safety and improve patient outcomes. Design: A quality improvement project using a quantitative descriptive design with a post program evaluation after educational video. Intervention: A 10-minute educational video on CHA2DS2-VASc and HAS-BLED delivered electronically. The education includes indication for using the CHA2DS2-VASc/HAS-BLED scales and anticoagulation decision-making Measurements: Self-reported knowledge gains and clinical practice changes after educational intervention on CHA2DS2-VASc/HAS-BLED using a Likert Scale via the Qualtrics platform. Setting: Yavapai Regional Medical Center in Prescott, Arizona. Participants: A total of 14 out of 36 providers of the Northern Arizona Hospitalist group participated in this quality improvement project. Results: The majority of participants of this quality improvement project self-reported knowledge enhancement on CHA2DS2-VASC (92.7%) and HASBLED (92.7%). Similarly, the majority of participants reported planned clinical practice changes based on CHA2DS2-VASC (85.7%) and HAS-BLED (78.6%). The majority of participants in this project reported intended clinical practice changes by evaluating risk stroke in atrial fibrillation with CHA2DS2-VASC (100%) and HAS-BLED (85.7%). Conclusions: This project showed CHA2DS2-VASc/HASBLED education to enhance knowledge of the risk evaluation scales and self-reported future changes in clinical practice changes due to the activities of this project in the majority of providers.