Impact of implementing common guidelines at different care levels in a healthcare area on the improvement of atrial fibrillation treatment

Introduction and objectives. Atrial fibrillation (AF) is treated in different settings by different specialists. The objective of the study was to analyze the impact of the implementation of a practice guideline about AF treatment common to the different levels of health attention on the adequacy of AF treatment and on corrective interventions. Methods. The study was performed in two periods, before and after the implementation of a practice guideline common to all health care levels. In each period, patients with AF who consulted to any of the health care attention levels of a sanitary area were included. Data referring to treatment and compliance of guidelines before and after the visit were recorded prospectively. Results. 293 patients were included in the first period and 267 in the second one. After the guideline implementation, adequacy before the visit, both of antiarrythmic treatment and of antithrombotic prophylaxis were superior than in the first period (80% vs 71%, P=.009 and 81% vs 67%, P < 001, respectively). The percentage of improvement in case of a previous inadequacy of antithrombotic prophylaxis was significantly better in the second period than in the first one (35% vs 9%, P <.001), but the percentage of corrective interventions on antiarrhythmic treatment was similar in both periods. Conclusions. The implementation of a common practice guideline in the different levels of health care attention is useful to improve adequacy of AF treatment, although there is still some reluctance to change an inadequate antiarrythmic treatment.