Atrial Fibrillation Treatment Trends Contradict Guidelines

One in 3 patients with atrial fibrillation (AF) and who have a moderate to high risk of stroke are not receiving guideline-recommended oral anticoagulation (OAC) therapy, according to a new study.

Current guidelines recommend prescribing OACs over aspirin for patients with AF and moderate to high risk of stroke. However, researchers were unsure of how many patients actually receive this treatment.
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To compare prescription of aspirin with prescription of OACs, the researchers examined 2 cohorts of outpatients with AF and moderate to high risk of stroke who were enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012.

The researchers categorized patients based on CHADS2 and CHA2DS2-VASc scores. There were 210,380 patients with a CHADS2 score of 2 or more, and 294,642 patients had a CHA2DS2-VASc score of 2 or more.

Of the patients with a CHADS2 score of 2 or more, 38% were treated with aspirin alone, and 62% were treated with warfarin or nonvitamin K antagonist OACs.

Of the patients with a CHA2DS2-VASc score of 2 or more, 40% were treated with aspirin alone, and 60% were treated with warfarin or nonvitamin K antagonist OACs.

Patients who were prescribed aspirin alone were more likely to have hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease.

Those on OAC therapy tended to be male, have a higher body mass index, have prior stroke/transient ischemic attack, have prior systemic embolism, and have congestive heart failure.

“In a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC,” the researchers concluded.

“Future studies should investigate the impact of the availability of non-vitamin K antagonist OACs on the choice of antithrombotic agent for patients with AF and the role of performance improvement programs on adherence to guideline-directed management.”

—Amanda Balbi

Reference:

Hsu JC, Maddox TM, Kennedy K, et al. Aspirin instead of oral anticoagulant prescription in atrial fibrillation patients at risk for stroke. J Am Coll Cardiol. 2016;67(25):2913-2923. doi:10.1016/j.jacc.2016.03.581.