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Although atrial fibrillation (AF) causes stroke, it is commonly undiagnosed prior to a stroke event, even among patients at high risk. We therefore evaluated the prevalence of AF-related symptoms and utilization of cardiac monitoring among patients at high risk of AF and stroke. We hypothesized that a large proportion of patients with risk of AF and of stroke had AF-related symptoms rather than clinically silent AF.
Using claims data from the Truven Health MarketScan® Commercial and Medicare Supplemental Databases, we identified patients with continuous medical and pharmacy enrollment for calendar year 2007 who met the criteria for cohort A, with a record of AF or stroke; or cohort B with risk of stroke based on six risk factors known to be associated with AF and stroke: 1) heart failure (HF), 2) hypertension (HTN), 3) diabetes, 4) age ≥65, 5) coronary artery disease (CAD), or 6) chronic kidney disease. Based on epidemiological data, we defined patients in cohort B as high risk of AF or stroke if they had 2 or more of the first four risk factors or 3 or more of any six risk factors. We then determined the prevalence of AF-related symptoms (chest pain, palpitations, dizziness, tachycardia, and respiratory abnormalities) and use of external cardiac monitoring among this high-risk group.
Of 19,173,907 patients with enrollment, 1.9% had recorded AF and/or stroke in 2007, and another 9.7% were identified as high risk for AF or stroke. Among high-risk patients, the most prevalent risk factors were HTN (95.3%), diabetes (52.9%), and age ≥65 (66.0%), and the most prevalent risk combinations were HTN + age ≥65 (34.4%) and HTN + diabetes (26.5%). Of 1,851,653 high risk patients, 28.0% had documentation of AF-related symptoms but only 4.3% of the patients with symptoms had evidence of external cardiac monitoring.
In an insured U.S. population at high risk for AF and stroke, there was a high prevalence of AF-related symptoms but extremely low use of external cardiac monitoring despite these symptoms. These findings may indicate a large clinical practice gap, and facilitation of appropriate use of external cardiac monitoring could lead to improved detection of AF and stroke prevention.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT III
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1151-45
- 2013 American College of Cardiology Foundation