Author + information
- William F. McIntyre,
- David Conen,
- Brian Olshansky,
- Jonathan Halperin,
- Emil Hayek,
- Menno Huisman,
- Gregory Lip,
- Shihai Lu and
- Jeff Healey
Background: Oral anticoagulation (OAC) with a vitamin K antagonist (VKA) or non-VKA OAC (NOAC) reduces stroke risk in patients with atrial fibrillation (AF). We aimed to identify factors affecting OAC prescription.
Methods: GLORIA-AF is an international, prospective, observational registry of patients with newly-diagnosed AF and CHA2DS2-VaSc scores >1. Choice of OAC is at physician discretion. We analyzed patients enrolled after approval of the first NOAC (Nov. 2011-Feb. 2014) and used multiple regression to identify patient, physician and temporal factors associated with OAC selection (VKA or NOAC) versus no OAC (aspirin or no antithrombotic therapy) in the North American cohort.
Results: Of 3,403 patients (mean age 71+11 years; CHA2DS2-VaSc score 1.5+1.0), 78.3%, 13.4% and 7.5% received OAC, aspirin or no antithrombotic therapy, respectively. Of those prescribed OAC, 66.5% received NOACs. Independent predictors of OAC therapy were heart failure (OR 1.4; 95% CI 1.0-1.9), prior stroke/transient ischemic attack (TIA) (OR 2.2; 95% CI 1.5-3.3), more concomitant medications (OR 1.7; 95% CI 1.3-2.2), commercial insurance (OR 1.5; 95% CI 1.1-2.0), non-paroxysmal AF (OR 1.9; 95% CI 1.5-2.6) and advanced age (coefficients for age and age^2: 0.1761, p=0.0003 and -0.00092, p=0.0097, respectively). Independent predictors of non-OAC management were female sex (OR 0.6, 95% CI 0.4-0.9), prior bleeding (OR 0.4; 95% CI 0.3-0.6), aspirin use (OR 0.2; 95% CI 0.1-0.2), prior falls (OR 0.4; 95% CI 0.3-0.7) and enrollment at a primary care site (OR 0.6; 95% CI 0.4-0.9). When the study period was divided into quartiles, there was no temporal change in odds of receiving OAC (p=0.481).
Conclusions: In the North American cohort, about one-fifth of patients with AF and CHA2DS2-VaSc score >1 did not receive OAC. Heart failure, stroke/TIA, more concomitant medications, commercial insurance, non-paroxysmal AF and increasing age predicted OAC use, whereas bleeding history and female sex predicted against OAC. These data provide insight into OAC use in a high-risk population.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Atrial Fibrillation and VT: Unique Populations and Solutions
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1151-105
- 2017 American College of Cardiology Foundation