• American heart journal · Jun 2018

    Predictors of oral anticoagulant non-prescription in patients with atrial fibrillation and elevated stroke risk.

    • Steven A Lubitz, Shaan Khurshid, Lu-Chen Weng, Gheorghe Doros, Joseph Walker Keach, Qi Gao, Anil K Gehi, Jonathan C Hsu, Matthew R Reynolds, Mintu P Turakhia, and Thomas M Maddox.
    • Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts; Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: slubitz@mgh.harvard.edu.
    • Am. Heart J. 2018 Jun 1; 200: 24-31.

    BackgroundMany patients with atrial fibrillation (AF) and elevated stroke risk are not prescribed oral anticoagulation (OAC) despite evidence of benefit. Identification of factors associated with OAC non-prescription could lead to improvements in care.Methods And ResultsUsing NCDR PINNACLE, a United States-based ambulatory cardiology registry, we examined factors associated with OAC non-prescription in patients with non-valvular AF at elevated stroke risk (CHA2DS2-VASc ≥2) between January 5, 2008 and December 31, 2014. Among 674,841 patients, 57% were treated with OAC (67% of whom were treated with warfarin). OAC prescription varied widely (28%-75%) across preselected strata of age, stroke risk (CHA2DS2-VASc), and bleeding risk (HAS-BLED), generally indicating that older patients at high stroke and low bleeding risk are commonly treated with OAC. Other factors associated with OAC non-prescription included reversible AF etiology; female sex; liver, renal, or vascular disease; and physician versus non-physician provider. Antiplatelet use was common (57%) and associated with the greatest risk of OAC non-prescription (odds ratio [OR] 4.44, 95% confidence interval [CI] 4.39-4.49).ConclusionsIn this registry of AF patients, older patients at elevated stroke and low bleeding risk were commonly treated with OAC. However, a variety of factors were associated with OAC non-prescription. Specifically, antiplatelet use was prevalent and associated with the highest likelihood of OAC non-prescription. Future studies are warranted to understand provider and patient rationale that may underlie observed associations with OAC non-prescription.Copyright © 2018 Elsevier Inc. All rights reserved.

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