The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries

Abstract

Aim: The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry's administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017-2021.

Methods and results: The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3-40.6) to 82.6% (95% CI: 82.1-83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA₂DS₂-VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6-85.9) to 90.4% (95% CI: 89.9-91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5-85.9) to 88.7% (95% CI: 88.0-89.3), and from 85.4% (95% CI: 84.7-86.2) to 88.2% (95% CI: 87.5-88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83-0.93) to 0.71% (95% CI: 0.66-0.75). Variation in clinical performance between the five administrative Danish regions was reduced.

Conclusion: Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.

Keywords: atrial fibrillation; quality indicators; quality of care.

Figure 1

The Danish Atrial Fibrillation Registry. Information flow between the steering committee, clinicians, and stakeholders, including hospital management, regional administrators, politicians, the national health board, and the national government.

Figure 2

(A) Echocardiography (non-linear trend; overall p=0.0581, within regions p=0.0101). (B) Patient education (non-linear trend, p<0.0001, p<0.0001). (C) TSH (non-linear trend; p<0.0001, p<0.0001). (D) Annual measurement of P-creatinine (non-linear trend; p<0.0001, p<0.0001).

Figure 3

(A) Initiation of OAC (non-linear trend; overall p=0.0034, within regions p=0.0002). (B) 1-year persistence to OAC (linear trend; p=0.2258, p=0.5078). (C) 2-year persistence to OAC (linear trend; p=0.4216, p=0.2154).

Figure 4

(A) Ischemic stroke (linear trend; overall p=0.0466, within regions p=0.1888). (B) Intracranial bleeding (linear trend; p=0.8807, p=0.9211). (C) Other major bleedings (linear trend; p=0.9109, p=0.9354).