Abstract 13111: The Registry to Evaluate Anticoagulation in Atrial Fibrillation (REAL-AF)
Background: Warfarin reduces the risk of stroke in patients (pts) with atrial fibrillation (AF) by approximately 40% compared to antiplatelet therapy, but is underutilized and its management can present challenges.
Methods: REAL-AF is a registry enrolling retrospective and prospective warfarin-naïve (< 60 days exposure) pts with newly-diagnosed (within last 3 mo.) non-valvular AF from up to 250 community-based US practices. This analysis focuses on the retrospective pts. Pts were enrolled consecutively. For all pts, baseline demographics and medical history were collected. For pts prescribed warfarin, healthcare resource utilization, time to reach and time in therapeutic range (TTR) were analyzed for a 6-month period. For those not on warfarin, reasons for not prescribing were collected by selecting from a list of commonly-cited reasons.
Results: Of 1490 retrospective pts from 156 sites, 67.4% (1004) were prescribed warfarin. Pts on warfarin were slightly older than those not on warfarin (72.3 vs. 69.2, p=0.0002). Pts were 51.9% (743/1431) male and 94.1% (1055/1121) white. Among the 1004 pts who received warfarin, within the first 6 months of therapy there were a total of 1065 physician office visits, 207 hospital visits, 105 ER visits, and 143 other healthcare utilization visits. Mean TTR (INR = 2.0–3.0) was 47.7% (N=770 pts). Median time to reach stable therapeutic range (3 consecutive INRs between 2.0 and 3.0) was 19.0 weeks (N=763 pts). Physician-perceived “low stroke risk” (46.1%; 224/486) and “high bleed risk” (25.5%; 124/486) were the most common reasons cited for not prescribing warfarin. Additional analyses indicated that pts with excessive fall risk were less likely to be prescribed warfarin (OR 0.145, 95% CI 0.094–0.225), while pts with conditions such as left ventricular dysfunction, hypertension, CAD, or CHF were more likely to be prescribed warfarin [Odds Ratios and (CIs) = 2.32 (1.65–3.26); 2.04 (1.57–2.64); 1.85 (1.43–2.40); 1.71 (1.25–2.34)].
Conclusion: A long period of time to reach therapeutic range and low TTR are common among newly diagnosed non-valvular AF pts with little or no previous exposure to warfarin. From this analysis it appears that these pts may not be deriving the full therapeutic benefit of anticoagulation therapy.
- © 2010 by American Heart Association, Inc.