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

Publication ,  Journal Article
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 in: Am J Med
July 2013

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.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

July 2013

Volume

126

Issue

7

Start / End Page

625 / 32.e1

Location

United States

Related Subject Headings

  • Risk Factors
  • Registries
  • Practice Guidelines as Topic
  • Platelet Aggregation Inhibitors
  • Male
  • Logistic Models
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
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Hess, P. L., Kim, S., Piccini, J. P., Allen, L. A., Ansell, J. E., Chang, P., … Fonarow, G. C. (2013). Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation. Am J Med, 126(7), 625-32.e1. https://doi.org/10.1016/j.amjmed.2013.01.037
Hess, Paul L., Sunghee Kim, Jonathan P. Piccini, Larry A. Allen, Jack E. Ansell, Paul Chang, James V. Freeman, et al. “Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation.Am J Med 126, no. 7 (July 2013): 625-32.e1. https://doi.org/10.1016/j.amjmed.2013.01.037.
Hess PL, Kim S, Piccini JP, Allen LA, Ansell JE, Chang P, et al. Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation. Am J Med. 2013 Jul;126(7):625-32.e1.
Hess, Paul L., et al. “Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation.Am J Med, vol. 126, no. 7, July 2013, pp. 625-32.e1. Pubmed, doi:10.1016/j.amjmed.2013.01.037.
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. Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation. Am J Med. 2013 Jul;126(7):625–32.e1.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

July 2013

Volume

126

Issue

7

Start / End Page

625 / 32.e1

Location

United States

Related Subject Headings

  • Risk Factors
  • Registries
  • Practice Guidelines as Topic
  • Platelet Aggregation Inhibitors
  • Male
  • Logistic Models
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • General & Internal Medicine
  • Female