Author + information
- Shaan Khurshid,
- Lu-Chen Weng,
- Olivia Hulme,
- Patrick T. Ellinor and
- Steven Lubitz
Background: Oral anticoagulation (OAC) in atrial fibrillation (AF) is effective yet underutilized. Factors associated with delayed OAC initiation after new diagnosis of AF are unknown.
Methods: In a large electronic medical record, we identified outpatients with new AF diagnosed 2006-2014 using a validated algorithm. In this cohort, we determined time to OAC and cumulative incidence of OAC 1 year after AF diagnosis. We examined baseline characteristics at AF diagnosis and their association with time to OAC using multivariable Cox modeling.
Results: Of 5,686 patients with incident AF, mean age was 70 and 46% were women. At 1 year, OAC incidence was 31.4% (95% CI 30.8-33.0). Among those with CHADS2 score ≥ 2, OAC incidence increased to 33.8% (95% CI 32.2-35.4). Most patients receiving OAC were treated with warfarin (82.5%) versus a non-vitamin K anticoagulant (17.5%). Among patients without prevalent stroke at AF diagnosis, 156 strokes occurred over 2,802 person-years (5.6%/person-yr) prior to OAC initiation. In multivariable analyses, factors associated with delay in initiation of OAC included female sex (HR 1.24, 95% CI 1.13-1.37), younger age (HR 1.13 per 10 yr decrease, 95% CI 1.08-1.18), earlier year of AF diagnosis (HR 1.03 per 1 yr decrease, 95% CI 1.01-1.05), absence of HTN (HR 1.22, 95% CI 1.08-1.39), non-private insurance (HR 1.18, 95% CI 1.04-1.34), previous fall (HR 2.15, 95% CI 1.27-3.66), dementia (HR 1.54, 95% CI 1.02-2.33), dual antiplatelet therapy (HR 2.76, 95% CI 1.07-7.11), and AF diagnosis in the emergency room (HR 3.03, 95% CI 1.93-4.78) or medical clinic (HR 1.32, 95% CI 1.06-1.64) relative to cardiology clinic. Among women, OAC prescription at 30 days, 6 months and 1 year was 20.0%, 25.6%, and 29.1%, whereas for males OAC prescription was 23.2%, 30.6%, and 34.1%.
Conclusions: OAC remains underutilized, with only 34% of patients with new AF and moderate to high stroke risk receiving OAC at 1 year. The stroke rate is substantial in the period between AF diagnosis and OAC initiation. Patients with younger age, female sex, non-private insurance, falls, dementia, dual antiplatelet therapy, or AF diagnosis in non-cardiology settings are at higher risk for receiving delayed or no anticoagulation.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1280-095
- 2017 American College of Cardiology Foundation