• David F Katz, Thomas M Maddox, Mintu Turakhia, Anil Gehi, Emily C O'Brien, Steven A Lubitz, Alexander Turchin, Gheorghe Doros, Lanyu Lei, Paul Varosy, Lucas Marzec, and Jonathan C Hsu.
• From the Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Denver (D.F.K., L.M.); Colorado Cardiovascular Outcomes Research Consortium, Denver (D.F.K., T.M.M., P.V., L.M.); Cardiology Section, VA Eastern Colorado Health Care System, Denver (T.M.M., P.V.); Section of Cardiac Electrophysiology, Division of Cardiology, Palo Alto VA Medical Center and Stanford University School of Medicine, CA (M.T.); Section of Cardiac Electrophysiology, Division of Cardiology, University of North Carolina, Chapel Hill (A.G.); Duke Clinical Research Institute, Durham, NC (E.C.O.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L.); Harvard Clinical Research Institute, Boston, MA (A.T., G.D., L.L.); Division of Endocrinology, Diabetes and Metabolism, Brigham and Women's Hospital, Boston, MA (A.T.); Harvard Medical School, Boston, MA (A.T.); Department of Biostatistics, Boston University, MA (G.D.); and Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (J.C.H.).
• Circ Cardiovasc Qual. 2017 May 1; 10 (5).

BackgroundUse of the CHA2DS2-VASc score instead of the CHADS2 score for thromboembolic risk stratification and initiation of oral anticoagulation (OAC) was recommended in the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines. We sought to define the proportion of patients with AF qualifying for and receiving OAC in contemporary practice by applying the CHA2DS2-VASc score to patients with a low CHADS2 score.Methods And ResultsAmong patients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's outpatient Practice Innovation and Clinical Excellence registry (2008-2014) CHADS2 score of 0 or 1, we calculated the impact of adoption of the CHA2DS2-VASc score on the proportion of patients with an indication for OAC. We examined trends in prescription of OAC overall, direct OAC (dabigatran/rivaroxaban/apixaban), and multivariable associations between clinical characteristics and OAC use. Of 346 068 patients with AF aged 65±12 years, 61% were men and 65% were white. In total, 24% of those with CHADS2=0 and 81% of those with a CHADS2=1 were reclassified as having a definite indication for OAC (CHA2DS2-VASc score ≥2). OAC use increased from 37% to 48% during the study period, and direct OAC use increased from 5% to 30%. Increasing CHA2DS2-VASc score (odds ratio, 2.07; 95% confidence interval, 1.97-2.19 for score of 4 versus 0) and rhythm control strategy (odds ratio, 1.34; 95% confidence interval, 1.30-1.39) were associated with increased OAC use.ConclusionsAdoption of the CHA2DS2-VASc score reclassifies 64.5% of patients with AF with low CHADS2 scores into a class I indication for OAC prescription. Overall OAC prescription increased between 2011 and 2014.© 2017 American Heart Association, Inc.

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