[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.255.49. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Original Investigation
April 2016

Oral Anticoagulant Therapy Prescription in Patients With Atrial Fibrillation Across the Spectrum of Stroke Risk: Insights From the NCDR PINNACLE Registry

Author Affiliations
  • 1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego
  • 2Division of Cardiology, Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver
  • 3Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver
  • 4Division of Cardiology, Department of Medicine, Colorado Cardiovascular Outcomes Research Consortium, Denver
  • 5Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
  • 6Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
  • 7Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill
  • 8Division of Cardiology, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
  • 9Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
  • 10Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
JAMA Cardiol. 2016;1(1):55-62. doi:10.1001/jamacardio.2015.0374
Abstract

Importance  Patients with atrial fibrillation (AF) are at a proportionally higher risk of stroke based on accumulation of well-defined risk factors.

Objective  To examine the extent to which prescription of an oral anticoagulant (OAC) in US cardiology practices increases as the number of stroke risk factors increases.

Design, Setting, and Participants  Cross-sectional registry study of outpatients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry’s PINNACLE (Practice Innovation and Clinical Excellence) Registry between January 1, 2008, and December 30, 2012. As a measure of stroke risk, we calculated the CHADS2 score and the CHA2DS2-VASc score for all patients. Using multinomial logistic regression models adjusted for patient, physician, and practice characteristics, we examined the association between increased stroke risk score and prescription of an OAC.

Main Outcomes and Measures  The primary outcome was prescription of an OAC with warfarin sodium or a non–vitamin K antagonist OAC.

Results  The study cohort comprised 429 417 outpatients with AF. Their mean (SD) age was 71.3 (12.9) years, and 55.8% were male. Prescribed treatment consisted of an OAC (192 600 [44.9%]), aspirin only (111 134 [25.9%]), aspirin plus a thienopyridine (23 454 [5.5%]), or no antithrombotic therapy (102 229 [23.8%]). Each 1-point increase in risk score was associated with increased odds of OAC prescription compared with aspirin-only prescription using the CHADS2 score (adjusted odds ratio, 1.158; 95% CI, 1.144-1.172; P < .001) and the CHA2DS2-VASc score (adjusted odds ratio, 1.163; 95% CI, 1.157-1.169; P < .001). Overall, OAC prescription prevalence did not exceed 50% even in higher-risk patients with a CHADS2 score exceeding 3 or a CHA2DS2-VASc score exceeding 4.

Conclusions and Relevance  In a large quality improvement registry of outpatients with AF, prescription of OAC therapy increased with a higher CHADS2 score and CHA2DS2-VASc score. However, a plateau of OAC prescription was observed, with less than half of high-risk patients receiving an OAC prescription.

×