Abstract 16811: Who’s Left Behind? Characterization of Atrial Fibrillation Outpatients Eligible but Untreated With Oral Anticoagulation
Background: Prior studies have demonstrated underuse of oral anticoagulant (OAC) therapy among patients with atrial fibrillation (AF). However, data characterizing which patients are eligible but untreated in the outpatient setting in the modern therapeutic era are sparse.
Methods: Using baseline data collected between June 2010 and August 2011 from 176 sites in ORBIT-AF, a US national registry of patients with AF, we compared characteristics of OAC recipients to those of non-recipients among those with a CHADS2 score > 1 without contraindications to OAC use and identified factors associated with OAC lack of treatment.
Results: Among 6,992 eligible patients, 1,219 (17.4%) received neither warfarin nor dabigatran. Compared with OAC recipients, non-recipients were younger (72 v. 76 years of age, p<0.001), less frequently had heart failure (23.6% v. 36.8%, p <0.001), and less commonly had a history of stroke (4.9% v. 9.8%, p<0.001). By contrast, rates of hypertension (89.4% v. 88.5%, p=0.332) and diabetes mellitus (31.6% v. 28.9%, p=0.052) were comparable between groups. Non-recipients were more likely to be prescribed antiplatelet therapy such as aspirin and clopidogrel (77.5% v. 42.7%, p<0.001) and less likely to abuse alcohol (3.3% v. 5.6%, p<0.001). Stratified logistic regression modeling identified several factors for non-receipt not included in traditional stroke or bleeding risk stratification schema (Table).
Conclusions: Up to 1 in 5 AF patients eligible for OAC therapy were untreated, particularly those at highest stroke risk. Factors related to AF duration, chronicity, and comorbidity are associated with OAC non-receipt and may inform future efforts at closing the treatment gap.
Author Disclosures: P.L. Hess: Honoraria; Modest; Sanofi-Aventis. S. Kim: None. J.P. Piccini: Research Grant; Modest; Boston-Scientific, Johnson & Johnson. Consultant/Advisory Board; Modest; Forest Laboratories, Johnson & Johnson, Medtronic, Inc.. L. Thomas: None. K.W. Mahaffey: Research Grant; Modest; Abbott Vascular Business, Abbott Vascular, Amgen, AstraZeneca, Baxter, Boehringer Ingelheim, Cordis, Cubist, Daiichi Sankyo, Edwards Lifesciences, Eli Lilly, GlaxoSmithKline, Guidant, Ikaria, Janssen, Johnson & Johnson, Luitpold, Medtronic, Merck & Co., Novartis, Portola Pharmaceutical, Pozen Pharmaceutical, Regado Biosciences, Inc., Regeneron, Roche Diagnostic, Sanofi, Schering-Plough, The Medicines Company. Consultant/Advisory Board; Modest; Adolor, American College of Cardiology, Amgen, Amylin/BMS, AstraZeneca, Biotronik, Boehringer Ingelheim, Bristol Myers Squibb, Cubist, Dialogues, Duke Center for Educational Excellence, Eli Lilly, Elsevier, Forest, Genentech, GlaxoSmithKline, Gilead, Haemonetics, Johns Hopkins University, Medtronic, Merck & Co., Ortho/McNeill, Pfizer, Polymedix, Purdue Pharma, Sanofi, South East Area Health Education Center, Springer Publishing, St. Jude Medical, Sun Pharma, University of British Columbia. Consultant/Advisory Board; Significant; Bayer Healthcare, Daiichi Sankyo, Johnson & Johnson. B. Gersh: Consultant/Advisory Board; Modest; Ortho-McNeill Jansen Pharmaceuticals. P.R. Kowey: Consultant/Advisory Board; Modest; Johnson & Johnson, Portola, Boehringer Ingelheim, Merck, Bristol Myers Squibb, Pfizer, AstraZeneca, Sanofi-Aventis, Daiichi Sankyo. F.C. Gregg: Consultant/Advisory Board; Modest; Medtronic, Inc. E.D. Peterson: Research Grant; Modest; Abbott Laboratories, Abiomed, Acorn Cardiovascular, Aastrom Biosciences.
- © 2014 by American Heart Association, Inc.