Military medicine · 2026
Clinical Performance and Quality Measures of Atrial Fibrillation Management for Active Duty Military Personnel in the U.S. Military Health System.
СтатьяНазвание и аннотация: Перевод в очереди
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Keithler Andrea N, Tunzi Matthew A, Wilson Andrew S, Bush Kelvin N V
Аннотация
INTRODUCTION: Atrial fibrillation (AF) in military members can impair military readiness and increase military care system burdens. Atrial fibrillation clinical care quality measures have not been assessed in military populations and facilities. This study aims to assess the AF management of United States active duty military service members according to guideline clinical quality measures.
MATERIALS AND METHODS: Ambulatory active duty personnel with AF diagnoses between 2004 and 2019 were analyzed in reference to the published AF clinical performance measures.
RESULTS: Three hundred eighty-six service members with AF were identified and analyzed. Nine of 11 outpatient clinical performance and quality measures were evaluated. Only 41% of encounters reported CHA2DS2-VASc scores with an increase in reporting to 64% for the more recent years 2014-2019. Nineteen of 22 (86%) personnel with indications for long-term anticoagulation received appropriate medical therapy. One hundred percent of 115 patients treated with warfarin were appropriately monitored with monthly INRs. Two patients with LVEF <40% were appropriately prescribed beta blockers. Two of 2 personnel with mechanical prosthetic valves were prescribed appropriate anticoagulation with warfarin. Thirty-one percent were inappropriately prescribed both an antiplatelet and an anticoagulant in the absence of coronary or vascular disease. Shared decision-making discussion regarding anticoagulant therapy was documented in 82%.
CONCLUSIONS: Active duty military personnel prescribed warfarin are appropriately monitored. Quality improvement processes can improve CHA2DS2-VASc score reporting, appropriate anticoagulation prescriptions, and shared decision-making discussions for military personnel with AF to reduce military health care system burdens and better outcomes for service members.
MATERIALS AND METHODS: Ambulatory active duty personnel with AF diagnoses between 2004 and 2019 were analyzed in reference to the published AF clinical performance measures.
RESULTS: Three hundred eighty-six service members with AF were identified and analyzed. Nine of 11 outpatient clinical performance and quality measures were evaluated. Only 41% of encounters reported CHA2DS2-VASc scores with an increase in reporting to 64% for the more recent years 2014-2019. Nineteen of 22 (86%) personnel with indications for long-term anticoagulation received appropriate medical therapy. One hundred percent of 115 patients treated with warfarin were appropriately monitored with monthly INRs. Two patients with LVEF <40% were appropriately prescribed beta blockers. Two of 2 personnel with mechanical prosthetic valves were prescribed appropriate anticoagulation with warfarin. Thirty-one percent were inappropriately prescribed both an antiplatelet and an anticoagulant in the absence of coronary or vascular disease. Shared decision-making discussion regarding anticoagulant therapy was documented in 82%.
CONCLUSIONS: Active duty military personnel prescribed warfarin are appropriately monitored. Quality improvement processes can improve CHA2DS2-VASc score reporting, appropriate anticoagulation prescriptions, and shared decision-making discussions for military personnel with AF to reduce military health care system burdens and better outcomes for service members.