• Lucas N Marzec, Jingyan Wang, Nilay D Shah, Paul S Chan, Henry H Ting, Kensey L Gosch, Jonathan C Hsu, and Thomas M Maddox.
• University of Colorado School of Medicine, Aurora, Colorado; Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado. Electronic address: lucas.marzec@ucdenver.edu.
• J. Am. Coll. Cardiol. 2017 May 23; 69 (20): 2475-2484.

BackgroundOral anticoagulation (OAC) with warfarin is underused for atrial fibrillation (AF). The availability of direct oral anticoagulants (DOACs) may improve overall OAC rates in AF patients, but a large-scale evaluation of their effects has not been conducted.ObjectivesThis study assessed the effect of DOAC availability on overall OAC rates for nonvalvular AF.MethodsBetween April 1, 2008 and September 30, 2014, we identified 655,000 patients with nonvalvular AF and a CHA2DS2-VASc score of >1 in the National Cardiovascular Data Registry PINNACLE registry. Temporal trends in overall OAC and individual warfarin and DOAC use were analyzed. Multivariable hierarchical logistic regression identified patient factors associated with OAC and DOAC use. Practice variation of OAC and DOAC use was also assessed.ResultsOverall OAC rates increased from 52.4% to 60.7% among eligible AF patients (p for trend <0.01). Warfarin use decreased from 52.4% to 34.8% (p for trend <0.01), and DOAC use increased from 0% to 25.8% (p for trend <0.01). An increasing CHA2DS2-VASc score was associated with higher OAC use (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.05 to 1.07), but with lower DOAC use (OR: 0.97; 95% CI: 0.96 to 0.98). Significant practice variation was present in OAC use (median odds ratio [MOR]: 1.52; 95% CI: 1.45 to 1.57) and in DOAC use (MOR: 3.58; 95% CI: 3.05 to 4.13).ConclusionsIntroduction of DOACs in routine practice was associated with improved rates of overall OAC use for AF, but significant gaps remain. In addition, there is significant practice-level variation in OAC and DOAC use.Copyright © 2017 American College of Cardiology Foundation. All rights reserved.

36 keywords...

hide…