AFib and Aflutter: Chronic Anticoagulation Therapy
Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation or atrial flutter whose assessment of the specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor, as determined by CHADS2 risk stratification, who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism .
ACP supports QPP measure 326: “Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy” because implementation may lead to meaningful improvements in clinical outcomes and a performance gap exists. While we support this measure, implementation could result in underuse of appropriately prescribed anticoagulation therapy. Denominator specifications include exclusion criteria for patients with a documented reason for not prescribing therapy. Inclusion of such broad exclusion criteria may discourage clinicians from prescribing therapy in patients where the benefits outweigh the risk of harms (e.g., documentation of "fall risk"). Developers should consider explicitly defining exclusion criteria to prevent underuse of anticoagulation therapy in clinically appropriate cases. Additionally, developers cite outdated evidence to form the basis of the measure. Developers should update the denominator specifications to include the CHADs2VASc risk stratification tool.