Trial: Gap between guidelines and routine medical practice in anticoagulation treatment of AF  Management and Outcomes in the Care of Atrial fibrillation in Germany (MOCA Trial)

Authors: McBride et al

Reference:  J Thromb Thrombolysis 2007;24:65-72   PMID:17260164

Purpose:  to evaluate the current anticoagulation treatment pattern in patients with AF in Germany.

Number of Patients: 361

Number of Centers: 45 general family, internal medicine, and cardiology practices

Design:   Multicenter observational study. Patients with AF were recruited in physician practices. Among 361 patients recruited, 90% had been treated with vitamin K antagonists at some time since AF diagnosis.

Authors Conclusion:   Monitored INR values were 56% of the time within, 14% below, and 30% over the recommended target range. Tendencies existed for younger patients with no documented risk factors for stroke to be over-treated with vitamin K antagonists, and for older patients without contraindications for anticoagulation to be undertreated. Examination of “real-life” data in treating patients with AF in Germany shows that there is the potential to advance the quality of care with respect to anticoagulation.

Key words:  atrial fibrillation

Comment: The implementation of guidelines for anticoagulation by practicing physicians involves individualized physician assessments of risks and benefits.  The tendency of physicians to be more aggressive with anticoagulation in younger patients and withhold it from older patients likely reflects a risk averse strategy that is warranted for some patients, but probably not to the extent observed.  Continued study is warranted as guidelines are adopted into clinical practice.

Summary written by William G. Stevenson, MD, FHRS