In Reply We appreciate the interest McAlister took in our recent article in JAMA Cardiology1 regarding oral anticoagulation prescription in patients with atrial fibrillation (AF) across the spectrum of stroke risk in the American College of Cardiology National Cardiovascular Data Registry Practice Innovation and Clinical Excellence Registry. The author highlights some of our main findings, including that oral anticoagulant (OAC) prescription prevalence did not surpass 50%, even in high-risk patients with a CHADS2 score greater than 3 and a CHA2DS2-VASc score greater than 4. Much of the focus of our article was on the observed underuse and plateau of OAC prescription such that half of patients with AF at moderate to high risk for stroke did not receive guideline-adherent therapy. However, the author is correct to point out that almost 1 in 3 patients at the lowest risk of stroke, with CHADS2 and CHA2DS2-VASc scores of 0, also received OAC prescription.
Hsu JC, Maddox TM, Marcus GM. Overtreatment of Low-Risk Patients With Atrial Fibrillation—The Quality Coin Has 2 Sides—Reply. JAMA Cardiol. 2016;1(7):849. doi:10.1001/jamacardio.2016.2273
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