Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation.

Journal Article (Journal Article)

BACKGROUND: Patients with atrial fibrillation often have cardiovascular risk factors or known comorbid disease, yet the use of evidence-based primary and secondary prevention cardiac therapy among atrial fibrillation outpatients is unknown. METHODS: Using baseline data collected between June 2010 and August 2011 from 174 sites participating in ORBIT-AF, a US national registry of patients with atrial fibrillation coordinated from Durham, NC, we examined professional guideline-recommended evidence-based therapy use for cardiovascular comorbid conditions and risk factors. Multivariable logistic regression was used to identify factors associated with receipt of all indicated evidence-based therapy. RESULTS: Among 10,096 enrolled patients, 93.5% were eligible for one or more evidence-based therapies. Among those eligible, 46.6% received all indicated therapies: 62.3% received an antiplatelet agent, 72.3% received a beta-blocker, 59.5% received an angiotensin-converting enzyme or angiotensin receptor blocker, 15.3% received an aldosterone antagonist, 65.7% received a statin, and 58.8% received an implantable cardioverter-defibrillator. A minority of patients with coronary artery disease, diabetes mellitus, heart failure, and peripheral vascular disease received all indicated therapies (25.1%, 43.2%, 42.5%, and 43.4%, respectively). A total of 52.4% of patients had controlled hypertension and 74.6% of patients with hyperlipidemia received a statin. Factors associated with nonreceipt of all indicated therapies included frailty, comorbid illness, geographic region, and antiarrhythmic drug therapy. CONCLUSIONS: The majority of eligible atrial fibrillation outpatients did not receive all guideline-recommended therapies for cardiovascular comorbid conditions and risk factors. This represents a potential opportunity to improve atrial fibrillation patients' quality of care and outcomes.

Full Text

Duke Authors

Cited Authors

  • Hess, PL; Kim, S; Piccini, JP; Allen, LA; Ansell, JE; Chang, P; Freeman, JV; Gersh, BJ; Kowey, PR; Mahaffey, KW; Thomas, L; Peterson, ED; Fonarow, GC

Published Date

  • July 2013

Published In

Volume / Issue

  • 126 / 7

Start / End Page

  • 625 - 32.e1

PubMed ID

  • 23787195

Pubmed Central ID

  • PMC4037289

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2013.01.037


  • eng

Conference Location

  • United States