Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines: Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation).

Published

Journal Article

It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes.Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications. We also analyzed the association between GC care and clinical outcomes at both the patient level and center level. A total of 9570 patients were included. The median age was 75 years (interquartile range, 67-82), and the median CHA2DS2-VASc score was 4 (interquartile range, 3-5). A total of 5977 patients (62.5%) received care that was concordant with all guideline recommendations for which they were eligible. Rates of GC care were higher in patients treated by providers with greater specialization in arrhythmias (60.0%, 62.4%, and 67.0% for primary care physicians, cardiologists, and electrophysiologists, respectively; P<0.001). During a median of 30 months of follow-up, patients treated with GC care had a higher risk of bleeding hospitalization (hazard ratio=1.21; P=0.021) but a similar risk of death, stroke, major bleeding, and all-cause hospitalization.Over a third of patients with atrial fibrillation in this large outpatient registry received care that differed in some respect from guideline recommendations. There was no apparent association between GC care and improved risk-adjusted outcomes.

Full Text

Duke Authors

Cited Authors

  • Barnett, AS; Kim, S; Fonarow, GC; Thomas, LE; Reiffel, JA; Allen, LA; Freeman, JV; Naccarelli, G; Mahaffey, KW; Go, AS; Kowey, PR; Ansell, JE; Gersh, BJ; Hylek, EM; Peterson, ED; Piccini, JP

Published Date

  • November 2017

Published In

Volume / Issue

  • 10 / 11

PubMed ID

  • 29141842

Pubmed Central ID

  • 29141842

Electronic International Standard Serial Number (EISSN)

  • 1941-3084

International Standard Serial Number (ISSN)

  • 1941-3149

Digital Object Identifier (DOI)

  • 10.1161/circep.117.005051

Language

  • eng