Abstract 3233: Anticoagulation Use In Patients With Atrial Fibrillation After AFFIRM And RACE
Introduction: Historical data indicate that about 40 to 60% of atrial fibrillation (AF) patients (pt) at high risk for embolism have been inadequately or un-anticoagulated (AC) with warfarin. AFFIRM and RACE, which compared rhythm control (RhC) and rate control (RaC) strategies for treating AF, revealed an ongoing increased embolic risk in high risk pt if AC was reduced or discontinued, even with a RhC strategy. To determine whether these observations have altered clinical practice, we examined the AFFECTS Registry.
Methods: The AFFECTS Registry is an onging observational study of (a) the treatment (Rx) patterns of 248 practicing U.S. cardiologists who were directly exposed to the 2001 ACC/AHA/ESC AF management guidelines subsequent to AFFIRM and RACE, and, (b) the Rx outcomes in the 1535 AF pt enrolled (predominantly having no or minimal structural heart disease or uncomplicated hypertension, with or without other conditions, including diabetes). In the AFFECTS Registry, which began enrolling patients in May 2005 and followed them for 1 year, we examined current AC use.
Results: In the 902 pt with evaluable data as of the planned interim analysis of Sept’06 [55.4% male, age 66.3+/− 13.1 yrs, 61% age 65 yrs or older, 14.4%>age 79], warfarin use during the registry was 68.9% in high risk RhC pr and 72.8% in high risk RaC pt (70.4% overall) versus 41.0% and 59.6% respectively in non-high risk RhC and RaC pt (46.4% overall). All but 12% of the high risk and 24% of the non-high risk pr received warfarin or aspirin Rx. Moreover, in these 902 pt both CNS bleeding and embolic rates have been low (1 pt each with CVA, embolic stroke, CNS bleed, TIA). There were 5 non-CNS bleeds. Bleeding contributed to 4 deaths (2 were CNS-related).
Conclusions: AC with warfarin by practicing cardiologists in AF pt has increased since AFFIRM and RACE, being >70% in high risk pt in AFFECTS and even 46% in non-high risk pt. In AFFECTS, despite increased AC use, bleeding rates have been low. The AFFECTS experience suggests that well performed clinical trials, such as AFFIRM and RACE, can alter physicians’ use of AC therapy.