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Research Letter
May 2015

Effect of the 2014 Atrial Fibrillation Guideline Revisions on the Proportion of Patients Recommended for Oral Anticoagulation

Author Affiliations
  • 1The Duke Clinical Research Institute, Durham, North Carolina
  • 2Departments of Medicine and Clinical Pharmacology, Jefferson Medical College, Philadelphia, Pennsylvania
  • 3Division of Cardiology, University of California, Los Angeles
JAMA Intern Med. 2015;175(5):848-850. doi:10.1001/jamainternmed.2015.13

In 2014, the American Heart Association, American College of Cardiology, and Heart Rhythm Society published a revised guideline for atrial fibrillation (AF) treatment recommending use of a refined stroke risk score and revised threshold for oral anticoagulation (OAC) initiation.1 We assessed the potential effect of this new guideline by comparing the proportion of patients with AF recommended for OAC under the 2011 and 2014 guidelines.1,2

We used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) study, a national, prospective, outpatient registry of AF in patients 18 years or older at 176 sites in the United States.3 The primary outcome was the proportion of patients recommended for OAC at baseline under each guideline. The CHADS2 score, recommended for stroke risk assessment by the 2011 guideline, incorporates information on prior stroke and transient ischemic attack, congestive heart failure and dysfunction, hypertension, age of 75 years or older, and diabetes mellitus (score range, 0-6).4 The revised 2014 guideline recommends use of the CHA2DS2-VASc score, which increases the point value from 1 to 2 for age of 75 years and older and adds elements for female sex, vascular disease, and age of 65 through 74 years (score range, 0-9).5 We considered only those patients with a definitive recommendation to be OAC recommended (CHADS2 score≥2 under the 2011 guideline2 and CHA2DS2-VASc score ≥2 under the 2014 guideline1). We also examined changes in recommendations according to age (<65 and ≥65 years) and sex. We used Pearson χ2 tests to compare the proportions.