Paul L Hess1, Sunghee Kim2, Gregg C Fonarow3, Laine Thomas2, Daniel E Singer4, James V Freeman5, Bernard J Gersh6, Jack Ansell7, Peter R Kowey8, Kenneth W Mahaffey9, Paul S Chan10, Benjamin A Steinberg11, Eric D Peterson2, Jonathan P Piccini2. 1. Cardiology Section, VA Eastern Colorado and Health Care System, Denver; Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora. Electronic address: paul.hess@ucdenver.edu. 2. Duke Clinical Research Institute, Durham, NC. 3. Department of Medicine, University of California, Los Angeles. 4. Harvard Medical School and Massachusetts General Hospital, Boston. 5. Department of Medicine, Yale University School of Medicine, New Haven, Conn. 6. Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn. 7. Department of Medicine, New York School of Medicine, Lenox Hill Hospital. 8. Lankenau Institute for Medical Research, Wynnewood, Penn. 9. Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif. 10. Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, Mo; Department of Medicine, University of Missouri-Kansas City. 11. Duke Clinical Research Institute, Durham, NC; University of Utah, Salt Lake City.
Abstract
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression. Using weighted Cox regression, we assessed the association between OAC non-use and subsequent outcomes over 2.5 years. RESULTS: Among 9553 patients, 2202 (23.0%) were not on OAC. Among OAC nonrecipients, 1846 (83.8%) had a CHA2DS2-VASc score ≥2. Factors independently associated with OAC non-use included atrial fibrillation type (paroxysmal odds ratio [OR] 0.73, 95% confidence interval [CI] 0.54-0.99; persistent OR 0.14, 95% CI 0.10-0.21; permanent OR 0.35, 95% CI 0.25-0.49; reference = new-onset), left atrial diameter enlargement (mild OR 0.80, 95% CI 0.66-0.97; moderate 0.58, 95% CI 0.47-0.73; severe 0.53, 95% CI 0.42-0.68; reference = normal diameter), and age >80 years (OR 1.04, 95% CI 1.02-1.08). Untreated patients had a higher risk of death (adjusted hazard ratio [HR] 1.22, 95% CI 1.05-1.41), a lower bleeding risk (adjusted HR 0.35, 95% CI 0.15-0.81), and a nonsignificant trend toward higher risk of stroke/non-central nervous system embolism/transient ischemic attack than those treated (adjusted HR 1.18, 95% CI 0.91-1.54). CONCLUSIONS: A majority of atrial fibrillation patients not treated with an OAC in current community practice meet guideline indications for treatment. Atrial fibrillation burden, chronicity, and comorbidity are associated with nontreatment. Untreated patients are at increased risk for adverse outcomes. Published by Elsevier Inc.
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression. Using weighted Cox regression, we assessed the association between OAC non-use and subsequent outcomes over 2.5 years. RESULTS: Among 9553 patients, 2202 (23.0%) were not on OAC. Among OAC nonrecipients, 1846 (83.8%) had a CHA2DS2-VASc score ≥2. Factors independently associated with OAC non-use included atrial fibrillation type (paroxysmal odds ratio [OR] 0.73, 95% confidence interval [CI] 0.54-0.99; persistent OR 0.14, 95% CI 0.10-0.21; permanent OR 0.35, 95% CI 0.25-0.49; reference = new-onset), left atrial diameter enlargement (mild OR 0.80, 95% CI 0.66-0.97; moderate 0.58, 95% CI 0.47-0.73; severe 0.53, 95% CI 0.42-0.68; reference = normal diameter), and age >80 years (OR 1.04, 95% CI 1.02-1.08). Untreated patients had a higher risk of death (adjusted hazard ratio [HR] 1.22, 95% CI 1.05-1.41), a lower bleeding risk (adjusted HR 0.35, 95% CI 0.15-0.81), and a nonsignificant trend toward higher risk of stroke/non-central nervous system embolism/transient ischemic attack than those treated (adjusted HR 1.18, 95% CI 0.91-1.54). CONCLUSIONS: A majority of atrial fibrillationpatients not treated with an OAC in current community practice meet guideline indications for treatment. Atrial fibrillation burden, chronicity, and comorbidity are associated with nontreatment. Untreated patients are at increased risk for adverse outcomes. Published by Elsevier Inc.
Entities:
Keywords:
Atrial fibrillation; Oral anticoagulation; Outcomes; Quality of care
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