TY - JOUR
T1 - Trends in antithrombotic therapy for atrial fibrillation
T2 - Data from the Veterans Health Administration Health System
AU - Buck, Joshua
AU - Kaboli, Peter
AU - Gage, Brian F.
AU - Cram, Peter
AU - Vaughan Sarrazin, Mary S.
N1 - Funding Information:
This work was supported by a Mentored Career Enhancement Award in Patient Centered Outcomes Research for Mid-Career and Senior Investigators (K18) provided to Dr. Vaughan Sarrazin by the Agency for Healthcare Research and Quality , and by the Health Services Research and Development Service of the Department of Veterans Affairs . Dr Peter Cram is supported by a K24 award from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) ( AR062133 ). The authors do not have any conflicts of interest or financial relationships related to the content of this manuscript. The authors had full access to and take full responsibility for the integrity of the data. This manuscript is not under review elsewhere, and there is no prior publication of manuscript contents. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Funding Information:
Unadjusted trends in the use of antithrombotics were evaluated using the Cochran-Armitage test for trend. Multivariable logistic regression was used to examine associations while controlling for risk factors that impact bleeding risk or potentially contraindicate anticoagulation. We used SAS version 9.3 (SAS Institute, Inc, Cary, NC) for all analyses. This study was approved by the Institutional Review Board of the Iowa City VA Medical Center and University of Iowa. This work was supported by awards from Agency for Healthcare Research and Quality , the Health Services Research and Development Service of the Department of Veterans Affairs , and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) . The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
Publisher Copyright:
© 2016
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Although controversial, several prior studies have suggested that oral anticoagulants (OACs) are underused in the US atrial fibrillation (AF) population. Appropriate use of OACs is essential because they significantly reduce the risk of stroke in those with AF. In the >2 million Americans with AF, OACs are recommended when the risk of stroke is moderate or high but not when the risk of stroke is low. To quantify trends and guideline adherence, we evaluated OAC use (either warfarin or dabigatran) in a 10-year period in patients with new AF in the Veterans Health Administration. Methods New AF was defined as at least 2 clinical encounters documenting AF within 120 days of each other and no previous AF diagnosis (N = 297,611). Congestive Heart Failure, Hypertension, Age > 75, Diabetes, and Stroke (CHADS2) scores were determined using age and diagnoses of hypertension, diabetes, heart failure, and stroke or transient ischemic attack during the 12 months before AF diagnosis. Receipt of an OAC within 90 days of a new diagnosis of AF was evaluated using VA pharmacy data. Results Overall, initiation of an OAC fell from 51.3% in 2002 to 43.1% in 2011. For patients with CHADS2 score of 0, 1, 2, 3, 4, and 5-6, the proportions of patients prescribed an OAC showed a relative decrease of 26%, 23%, 14%, 12%, 9%, and 13%, respectively (P <.001). Clopidogrel use was stable at 10% of the AF population. Conclusions Among US veterans with new AF and additional risk factors for stroke, only about half receive OAC, and the proportion is declining.
AB - Background Although controversial, several prior studies have suggested that oral anticoagulants (OACs) are underused in the US atrial fibrillation (AF) population. Appropriate use of OACs is essential because they significantly reduce the risk of stroke in those with AF. In the >2 million Americans with AF, OACs are recommended when the risk of stroke is moderate or high but not when the risk of stroke is low. To quantify trends and guideline adherence, we evaluated OAC use (either warfarin or dabigatran) in a 10-year period in patients with new AF in the Veterans Health Administration. Methods New AF was defined as at least 2 clinical encounters documenting AF within 120 days of each other and no previous AF diagnosis (N = 297,611). Congestive Heart Failure, Hypertension, Age > 75, Diabetes, and Stroke (CHADS2) scores were determined using age and diagnoses of hypertension, diabetes, heart failure, and stroke or transient ischemic attack during the 12 months before AF diagnosis. Receipt of an OAC within 90 days of a new diagnosis of AF was evaluated using VA pharmacy data. Results Overall, initiation of an OAC fell from 51.3% in 2002 to 43.1% in 2011. For patients with CHADS2 score of 0, 1, 2, 3, 4, and 5-6, the proportions of patients prescribed an OAC showed a relative decrease of 26%, 23%, 14%, 12%, 9%, and 13%, respectively (P <.001). Clopidogrel use was stable at 10% of the AF population. Conclusions Among US veterans with new AF and additional risk factors for stroke, only about half receive OAC, and the proportion is declining.
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U2 - 10.1016/j.ahj.2016.03.029
DO - 10.1016/j.ahj.2016.03.029
M3 - Article
C2 - 27595695
AN - SCOPUS:84989336895
SN - 0002-8703
VL - 179
SP - 186
EP - 191
JO - American Heart Journal
JF - American Heart Journal
ER -