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Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.

Publication ,  Journal Article
Cullen, MW; Kim, S; Piccini, JP; Ansell, JE; Fonarow, GC; Hylek, EM; Singer, DE; Mahaffey, KW; Kowey, PR; Thomas, L; Go, AS; Lopes, RD ...
Published in: Circ Cardiovasc Qual Outcomes
July 2013

BACKGROUND: Patients with atrial fibrillation (AF) at the highest stroke risk derive the largest benefit from oral anticoagulation (OAC). Those with the highest stroke risk have been paradoxically less likely to receive OAC. This study assessed the association between stroke and bleeding risk on rates of OAC. METHODS AND RESULTS: We analyzed OAC use among 10,098 patients with AF from 174 community-based outpatient practices enrolled in 2010-2011 in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). OAC was defined as warfarin or dabigatran use at study enrollment. Stroke and bleeding risk were calculated using congestive heart failure, hypertension, age, diabetes mellitus, prior stroke (CHADS₂), and anticoagulation and risk factors in AF (ATRIA) scores, respectively. The mean subject age was 73 years; 58% were men. Overall, 76% of patients received OAC (71% warfarin and 5% dabigatran). The use of OAC increased among those with higher CHADS₂ scores, from 53% for CHADS₂=0 to 80% for CHADS₂≥2 (P<0.001). OAC use fell slightly with increasing ATRIA bleeding risk score, from 81% for ATRIA=3 to 73% for ATRIA≥5 (P<0.001). A significant interaction existed between ATRIA and CHADS₂ scores (P=0.021). Among those with low bleeding risk, use of OAC increased significantly with increasing stroke risk. Among those with high bleeding risk, CHADS₂ stroke risk had a smaller impact on use of OAC. CONCLUSIONS: In community-based outpatients with AF, use of OAC was high and driven by not only predominantly stroke but also bleeding risk. Stroke risk significantly affects OAC use among those with low bleeding risk, whereas those with high bleeding risk demonstrate consistently lower use of OAC regardless of stroke risk.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2013

Volume

6

Issue

4

Start / End Page

461 / 469

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Quality Indicators, Health Care
  • Quality Improvement
  • Prospective Studies
  • Patient Selection
 

Citation

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Cullen, M. W., Kim, S., Piccini, J. P., Ansell, J. E., Fonarow, G. C., Hylek, E. M., … ORBIT-AF Investigators. (2013). Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Circ Cardiovasc Qual Outcomes, 6(4), 461–469. https://doi.org/10.1161/CIRCOUTCOMES.113.000127
Cullen, Michael W., Sunghee Kim, Jonathan P. Piccini, Jack E. Ansell, Greg C. Fonarow, Elaine M. Hylek, Daniel E. Singer, et al. “Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.Circ Cardiovasc Qual Outcomes 6, no. 4 (July 2013): 461–69. https://doi.org/10.1161/CIRCOUTCOMES.113.000127.
Cullen MW, Kim S, Piccini JP, Ansell JE, Fonarow GC, Hylek EM, et al. Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):461–9.
Cullen, Michael W., et al. “Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.Circ Cardiovasc Qual Outcomes, vol. 6, no. 4, July 2013, pp. 461–69. Pubmed, doi:10.1161/CIRCOUTCOMES.113.000127.
Cullen MW, Kim S, Piccini JP, Ansell JE, Fonarow GC, Hylek EM, Singer DE, Mahaffey KW, Kowey PR, Thomas L, Go AS, Lopes RD, Chang P, Peterson ED, Gersh BJ, ORBIT-AF Investigators. Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):461–469.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2013

Volume

6

Issue

4

Start / End Page

461 / 469

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Quality Indicators, Health Care
  • Quality Improvement
  • Prospective Studies
  • Patient Selection