Joshua Buck1, Peter Kaboli2, Brian F Gage3, Peter Cram4, Mary S Vaughan Sarrazin5. 1. Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, IA. Electronic address: joshua-buck@uiowa.edu. 2. Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, IA; Department of Internal Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa, Iowa City, IA. 3. Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO. 4. Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada. 5. Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, IA; Department of Internal Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: mary-vaughan-sarrazin@uiowa.edu.
Abstract
BACKGROUND: Although controversial, several prior studies have suggested that oral anticoagulants (OACs) are underused in the US atrial fibrillation (AF) population. Appropriate use of OACs is essential because they significantly reduce the risk of stroke in those with AF. In the >2 million Americans with AF, OACs are recommended when the risk of stroke is moderate or high but not when the risk of stroke is low. To quantify trends and guideline adherence, we evaluated OAC use (either warfarin or dabigatran) in a 10-year period in patients with new AF in the Veterans Health Administration. METHODS: New AF was defined as at least 2 clinical encounters documenting AF within 120 days of each other and no previous AF diagnosis (N = 297,611). Congestive Heart Failure, Hypertension, Age > 75, Diabetes, and Stroke (CHADS2) scores were determined using age and diagnoses of hypertension, diabetes, heart failure, and stroke or transient ischemic attack during the 12 months before AF diagnosis. Receipt of an OAC within 90 days of a new diagnosis of AF was evaluated using VA pharmacy data. RESULTS: Overall, initiation of an OAC fell from 51.3% in 2002 to 43.1% in 2011. For patients with CHADS2 score of 0, 1, 2, 3, 4, and 5-6, the proportions of patients prescribed an OAC showed a relative decrease of 26%, 23%, 14%, 12%, 9%, and 13%, respectively (P < .001). Clopidogrel use was stable at 10% of the AF population. CONCLUSIONS: Among US veterans with new AF and additional risk factors for stroke, only about half receive OAC, and the proportion is declining. Published by Elsevier Inc.
BACKGROUND: Although controversial, several prior studies have suggested that oral anticoagulants (OACs) are underused in the US atrial fibrillation (AF) population. Appropriate use of OACs is essential because they significantly reduce the risk of stroke in those with AF. In the >2 million Americans with AF, OACs are recommended when the risk of stroke is moderate or high but not when the risk of stroke is low. To quantify trends and guideline adherence, we evaluated OAC use (either warfarin or dabigatran) in a 10-year period in patients with new AF in the Veterans Health Administration. METHODS: New AF was defined as at least 2 clinical encounters documenting AF within 120 days of each other and no previous AF diagnosis (N = 297,611). Congestive Heart Failure, Hypertension, Age > 75, Diabetes, and Stroke (CHADS2) scores were determined using age and diagnoses of hypertension, diabetes, heart failure, and stroke or transient ischemic attack during the 12 months before AF diagnosis. Receipt of an OAC within 90 days of a new diagnosis of AF was evaluated using VA pharmacy data. RESULTS: Overall, initiation of an OAC fell from 51.3% in 2002 to 43.1% in 2011. For patients with CHADS2 score of 0, 1, 2, 3, 4, and 5-6, the proportions of patients prescribed an OAC showed a relative decrease of 26%, 23%, 14%, 12%, 9%, and 13%, respectively (P < .001). Clopidogrel use was stable at 10% of the AF population. CONCLUSIONS: Among US veterans with new AF and additional risk factors for stroke, only about half receive OAC, and the proportion is declining. Published by Elsevier Inc.
Authors: Valentin Fuster; Lars E Rydén; David S Cannom; Harry J Crijns; Anne B Curtis; Kenneth A Ellenbogen; Jonathan L Halperin; Jean-Yves Le Heuzey; G Neal Kay; James E Lowe; S Bertil Olsson; Eric N Prystowsky; Juan Luis Tamargo; Samuel Wann; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffery L Anderson; Elliott M Antman; Jonathan L Halperin; Sharon Ann Hunt; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano Journal: Circulation Date: 2006-08-15 Impact factor: 29.690
Authors: John J You; Daniel E Singer; Patricia A Howard; Deirdre A Lane; Mark H Eckman; Margaret C Fang; Elaine M Hylek; Sam Schulman; Alan S Go; Michael Hughes; Frederick A Spencer; Warren J Manning; Jonathan L Halperin; Gregory Y H Lip Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: S Connolly; J Pogue; R Hart; M Pfeffer; S Hohnloser; S Chrolavicius; M Pfeffer; S Hohnloser; S Yusuf Journal: Lancet Date: 2006-06-10 Impact factor: 79.321
Authors: John A Cairns; Stuart Connolly; Sean McMurtry; Michael Stephenson; Mario Talajic Journal: Can J Cardiol Date: 2011 Jan-Feb Impact factor: 5.223
Authors: Daniel E Singer; Gregory W Albers; James E Dalen; Margaret C Fang; Alan S Go; Jonathan L Halperin; Gregory Y H Lip; Warren J Manning Journal: Chest Date: 2008-06 Impact factor: 9.410
Authors: Michael W Cullen; Sunghee Kim; Jonathan P Piccini; Jack E Ansell; Greg C Fonarow; Elaine M Hylek; Daniel E Singer; Kenneth W Mahaffey; Peter R Kowey; Laine Thomas; Alan S Go; Renato D Lopes; Paul Chang; Eric D Peterson; Bernard J Gersh Journal: Circ Cardiovasc Qual Outcomes Date: 2013-06-11
Authors: Stuart J Connolly; Janice Pogue; Robert G Hart; Stefan H Hohnloser; Marc Pfeffer; Susan Chrolavicius; Salim Yusuf Journal: N Engl J Med Date: 2009-03-31 Impact factor: 91.245
Authors: Ajay K Kakkar; Iris Mueller; Jean-Pierre Bassand; David A Fitzmaurice; Samuel Z Goldhaber; Shinya Goto; Sylvia Haas; Werner Hacke; Gregory Y H Lip; Lorenzo G Mantovani; Alexander G G Turpie; Martin van Eickels; Frank Misselwitz; Sophie Rushton-Smith; Gloria Kayani; Peter Wilkinson; Freek W A Verheugt Journal: PLoS One Date: 2013-05-21 Impact factor: 3.240
Authors: Nicolae Done; Amanda M Roy; Yingzhe Yuan; Steven D Pizer; Adam J Rose; Julia C Prentice Journal: Health Serv Res Date: 2018-11-11 Impact factor: 3.402