Professional Documents
Culture Documents
Clinical Research Institute, Durham, NC; 2Yale School of Medicine, New Haven, CT; 3Hofstra North Shore/LIJ School of Medicine, Hempstead, NY; 4Jefferson Medical College, Wynnewood, PA; 5Boston University School of Medicine, Boston, MA;
6University of Missouri, Kansas City, KS ; 7Stanford University School of Medicine, Stanford, CA; 8Janssen Scientific Affairs, Raritan, NJ; 9Kaiser Permanente Division of Research, Oakland, CA; 10UCLA Division of Cardiology, Los Angeles, CA
BACKGROUND
Since the publication of the 2006
ACC/AHA/ESC atrial fibrillation (AF)
treatment guidelines, the face of AF
management has changed considerably
Minor risk factors for stroke in AF, including
coronary artery disease, age 65-74, and
female sex, have recently been validated in
independent AF cohorts
The 2014 AHA/ACC/HRS AF treatment
guidelines reflect this new emphasis,
supporting the use of CHA2DS2-VASc as
the basis for antithrombotic treatment
recommendations, as well as a revised risk
threshold for treatment
The potential impact of the new guideline
on the proportion of patients recommended
for OAC treatment is unknown.
OBJECTIVES
Assess the magnitude of the potential
impact of the new guideline on the
proportion of AF patients recommended for
OAC treatment
Estimate the potential increase in number
of AF patients treated with OAC expected
with adoption of the new guideline.
METHODS
RESULTS
RESULTS
CHADS2
2011
Guideline
CHA2DS2VASc
2014 Guideline
Aspirin
None
Aspirin or OAC
Consider OAC/APT
>2
OAC
>2
OAC
OAC
Neither
Both
Recommended
Guideline
Guidelines under 2014 but
PRecommended/
Recommended
not 2011
Value*
Optional OAC
(N=7275)
Guideline
(N=930)
(N=1926)
Variable
Demographics
Age, median
(IQR)
White Race
Female
Medical History
Current Smoker
Hypertension
Diabetes
Renal Disease
Anemia
Stroke or TIA
Prior MI
ATRIA bleeding
score, median (IQR)
Currently taking
antithrombotics
OAC
Dabigatran
Warfarin
OAC contraindication
59.0
(52.0, 63.0)
87.9
10.8
78.0
(71.0, 83.0)
89.2
45.2
70.0
(66.0, 74.0)
90.1
46.8
10.1
41.1
2.4
7.5
4.4
0.0
0.5
5.0
93.3
40.0
40.5
21.8
21.0
19.2
6.9
64.4
2.5
23.1
11.7
0.0
10.7
<.0001
<.0001
<.0001
<.0001
<.0001
<.0001
<.0001
1.0
(0.0, 1.0)
3.0
(2.0, 4.0)
1.0
(2.0, 3.0)
<.0001
49.6
43.8
42.7
0.0014
56.6
7.1
49.5
80.1
4.4
75.8
70.7
6.3
64.4
<.0001
<.0001
<.0001
8.5
13.7
11.4
<.0001
<.0001
0.0494
<.0001
# Recommended
under 2014
Guideline
(Column B
Column A)
Overall
3734100
4722600
988500
Men
2046400
2572300
525900
Women
1687800
2150400
462600
<65
452700
636500
183800
>65
3281300
4086300
805000
CONCLUSIONS
Under the 2014 guideline, 2 out of 3 AF patients who were
not previously recommended for OAC were reclassified as
OAC recommended
Nearly one-third of AF patients newly recommended under
the 2014 guideline were not receiving OAC at baseline
enrollment
Under the 2014 guideline, women and patients over the age
of 65 had near-universal OAC recommendations
Future studies evaluating longitudinal changes in
anticoagulation treatment patterns and barriers to initiation
and persistence among patients reclassified by the new
guideline are warranted.