Abstract 18703: Impact of the 2014 Atrial Fibrillation Guideline on the Proportion of Patients Recommended for Oral Anticoagulation
Introduction: In 2014, the AHA/ACC/HRS published new atrial fibrillation (AF) treatment guidelines recommending use of a refined stroke risk score and revised threshold for oral anticoagulation (OAC) initiation.
Methods: Using data from ORBIT-AF, an ongoing, national, outpatient AF registry conducted at 176 sites, we examined changes in the number of patients qualifying for OAC based on clinical stroke risk scores under 2011 ACCF/AHA/HRS versus 2014 AHA/ACC/HRS guidelines. Patients were considered recommended for OAC under the 2011 guideline with a CHADS2 score >=2 and under the 2014 guideline with a CHA2DS2-VASC score >=2. We reported the fraction of patients treated with OAC (warfarin or dabigatran) among patients qualifying for OAC under each guideline.
Results: From 2009 - 2010, 10132 patients were enrolled in ORBIT-AF (median age [IQR] = 75 years [67 - 82]; 42.3% female). The proportion of patients qualifying for OAC increased from 71.8% under the 2011 guideline to 90.8% under the 2014 guideline (Figure). For patients under the age of 65, the proportion qualifying for treatment with OAC increased from 43.1% to 60.6%. Similar increases were observed for patients over the age of 65: 79.1% indicated for OAC under the 2011 guideline, compared with 98.5% under the 2014 guideline. There were 97.7% of women who qualified for OAC under the 2014 guideline, compared with 76.7% under the 2011 guideline. The fraction of indicated patients who were not receiving OAC increased under the 2014 guideline (21.9% vs. 19.9% under the 2011 guideline), with the highest undertreatment rates for patients younger than 65 (25.4%).
Conclusions: The 2014 AF treatment guideline substantially increased the proportion of patients who qualified for OAC, with near-universal indication for women and for patients older than 65. Under the 2014 guideline, approximately 22% of the indicated patients in our community-based cohort did not receive OAC.
Author Disclosures: E.C. O’Brien: None. S. Kim: None. P.L. Hess: None. J.V. Freeman: None. L. Thomas: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Ortho McNeil. J.E. Ansell: Consultant/Advisory Board; Modest; Bristol Myers Squibb, Pfizer, Janssen, Daiichi, Boehringer Ingelheim, Alere. P.R. Kowey: Consultant/Advisory Board; Modest; Boehringer Ingelheim, Bristol Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, Daiichi Sankyo. E.M. Hylek: Speakers Bureau; Modest; Boehringer-Ingelheim, Bayer. Consultant/Advisory Board; Modest; Johnson & Johnson, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, Ortho-McNeil-Janssen. K.W. Mahaffey: Research Grant; Modest; AstraZeneca, Amgen, Bayer, Boehringer-Ingleheim, Bristol-Myers-Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Portola, POZEN Pharmaceutical, Schering-Plough, a. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, Glaxo SmithKline, Johnson & Johnson, and Merck. P. Chang: Employment; Significant; Employee of Janssen Scientific Affairs. J.P. Piccini: Research Grant; Significant; Boston Scientific Corporation and Janssen. Consultant/Advisory Board; Modest; Forest Laboratories, Janssen, and Medtronic. E.D. Peterson: Research Grant; Significant; Eli Lilly & Company and Janssen.
- © 2014 by American Heart Association, Inc.