Andrew C T Ha1, Narendra Singh2, Jafna L Cox3, G B John Mancini4, Paul Dorian5, Carl Fournier6, David J Gladstone7, Evan Lockwood8, Ashfaq Shuaib8, Mahesh Kajil9, Michelle Tsigoulis9, Milan K Gupta10. 1. Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Georgia Regents University, Augusta, Georgia, USA. 3. Dalhousie University, Halifax, Nova Scotia, Canada. 4. University of British Columbia, Vancouver, British Columbia, Canada. 5. Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 6. University of Montreal, Montreal, Québec, Canada. 7. Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. 8. University of Alberta, Edmonton, Alberta, Canada. 9. Canadian Cardiovascular Research Network, Brampton, Ontario, Canada. 10. Canadian Cardiovascular Research Network, Brampton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada. Electronic address: mkgupta@ccrnmd.com.
Abstract
BACKGROUND: We explored patterns of and factors associated with the use of oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) in contemporary Canadian practice. METHODS: Phase 1 of the Stroke Prevention and Rhythm Intervention in Atrial Fibrillation (SPRINT-AF) registry was a cross-sectional retrospective study of patients with nonvalvular AF (NVAF). From December 2012-July 2013, 936 consecutive patients with NVAF were enrolled in SPRINT-AF. Of the 782 patients treated with OAC, the proportion treated withwarfarin and a new oral anticoagulant (NOAC) was 53.2% and 46.8%, respectively. The rate of OAC use was 90.9% among patients with a CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score ≥ 2. RESULTS: On multivariable analysis, the 2 strongest factors associated with NOAC use (compared with warfarin use) were an improved side effect profile (as perceived by the patient) and improved efficacy (as perceived by the physician) (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.06-0.17; P < 0.01 and OR, 0.52; 95% CI, 0.36-0.76; P < 0.01, respectively). Lower cost was strongly associated with warfarin use (OR, 5.16; 95% CI, 3.49-7.63; P < 0.01). CONCLUSIONS: In this contemporary Canadian AF registry, the rate of guideline-concordant OAC use was high. About half of OAC-treated patients received NOACs. Patient- and physician-driven preferences, such as side effect profile, perceived greater efficacy, and cost, were strong determinants of NOAC use over warfarin use.
RCT Entities:
BACKGROUND: We explored patterns of and factors associated with the use of oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) in contemporary Canadian practice. METHODS: Phase 1 of the Stroke Prevention and Rhythm Intervention in Atrial Fibrillation (SPRINT-AF) registry was a cross-sectional retrospective study of patients with nonvalvular AF (NVAF). From December 2012-July 2013, 936 consecutive patients with NVAF were enrolled in SPRINT-AF. Of the 782 patients treated with OAC, the proportion treated with warfarin and a new oral anticoagulant (NOAC) was 53.2% and 46.8%, respectively. The rate of OAC use was 90.9% among patients with a CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score ≥ 2. RESULTS: On multivariable analysis, the 2 strongest factors associated with NOAC use (compared with warfarin use) were an improved side effect profile (as perceived by the patient) and improved efficacy (as perceived by the physician) (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.06-0.17; P < 0.01 and OR, 0.52; 95% CI, 0.36-0.76; P < 0.01, respectively). Lower cost was strongly associated with warfarin use (OR, 5.16; 95% CI, 3.49-7.63; P < 0.01). CONCLUSIONS: In this contemporary Canadian AF registry, the rate of guideline-concordant OAC use was high. About half of OAC-treated patients received NOACs. Patient- and physician-driven preferences, such as side effect profile, perceived greater efficacy, and cost, were strong determinants of NOAC use over warfarin use.
Authors: Jean-Eric Tarride; Lisa Dolovich; Gordon Blackhouse; Jason Robert Guertin; Natasha Burke; Veena Manja; Alex Grinvalds; Ting Lim; Jeff S Healey; Roopinder K Sandhu Journal: CMAJ Open Date: 2017-08-22