TY - JOUR
T1 - Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
AU - Hsu, Jonathan C.
AU - Maddox, Thomas M.
AU - Kennedy, Kevin
AU - Katz, David F.
AU - Marzec, Lucas N.
AU - Lubitz, Steven A.
AU - Gehi, Anil K.
AU - Turakhia, Mintu P.
AU - Marcus, Gregory M.
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this paper represent those of the authors, and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . PINNACLE Registry is an initiative of the American College of Cardiology Foundation. Bristol-Myers Squibb and Pfizer Inc. are Founding Sponsors of the PINNACLE Registry. Dr. Hsu has received honoraria from St. Jude Medical, Medtronic, Biotronik, Janssen Pharmaceutical, and Bristol-Myers Squibb; has received research support from Biotronik and Biosense Webster. Dr. Lubitz has received grants from the National Institutes of Health (NIH) and the Doris Duke Charitable Foundation. Dr. Gehi has received speaker honoraria from Medtronic, Zoll Medical, St. Jude Medical, and Biotronik. Dr. Turakhia has received research support from the Veterans Affairs, Gilead Sciences, iRhythm, Medtronic, Janssen Pharmaceuticals, and SentreHeart; is a consultant to Janssen Pharmaceuticals, Medtronic, St. Jude Medical, and Precision Health Economics; and has equity ownership in thryva and Zipline. Dr. Marcus has received research support from the NIH, PCORI, Medtronic, Pfizer, Rhythm Diagnostic Systems, and SentreHeart; and is a consultant for and has equity ownership in InCarda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/6/28
Y1 - 2016/6/28
N2 - Background Oral anticoagulation (OAC), rather than aspirin, is recommended in patients with atrial fibrillation (AF) at moderate to high risk of stroke. Objectives This study sought to examine patient and practice-level factors associated with prescription of aspirin alone compared with OAC in AF patients at intermediate to high stroke risk in real-world cardiology practices. Methods The authors identified 2 cohorts of outpatients with AF and intermediate to high thromboembolic risk (CHADS2 score ≥2 and CHA2DS2-VASc ≥2) enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient and practice characteristics, the authors examined the prevalence and predictors of aspirin alone versus OAC prescription in AF patients at risk for stroke. Results Of 210,380 identified patients with CHADS2 score ≥2 on antithrombotic therapy, 80,371 (38.2%) were treated with aspirin alone, and 130,009 (61.8%) were treated with warfarin or non-vitamin K antagonist OACs. In the cohort of 294,642 patients with CHA2DS2-VASc ≥2, 118,398 (40.2%) were treated with aspirin alone, and 176,244 (59.8%) were treated with warfarin or non-vitamin K antagonist OACs. After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were associated with prescription of aspirin only, whereas male sex, higher body mass index, prior stroke/transient ischemic attack, prior systemic embolism, and congestive heart failure were associated with more frequent prescription of OAC. Conclusions In a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
AB - Background Oral anticoagulation (OAC), rather than aspirin, is recommended in patients with atrial fibrillation (AF) at moderate to high risk of stroke. Objectives This study sought to examine patient and practice-level factors associated with prescription of aspirin alone compared with OAC in AF patients at intermediate to high stroke risk in real-world cardiology practices. Methods The authors identified 2 cohorts of outpatients with AF and intermediate to high thromboembolic risk (CHADS2 score ≥2 and CHA2DS2-VASc ≥2) enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient and practice characteristics, the authors examined the prevalence and predictors of aspirin alone versus OAC prescription in AF patients at risk for stroke. Results Of 210,380 identified patients with CHADS2 score ≥2 on antithrombotic therapy, 80,371 (38.2%) were treated with aspirin alone, and 130,009 (61.8%) were treated with warfarin or non-vitamin K antagonist OACs. In the cohort of 294,642 patients with CHA2DS2-VASc ≥2, 118,398 (40.2%) were treated with aspirin alone, and 176,244 (59.8%) were treated with warfarin or non-vitamin K antagonist OACs. After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were associated with prescription of aspirin only, whereas male sex, higher body mass index, prior stroke/transient ischemic attack, prior systemic embolism, and congestive heart failure were associated with more frequent prescription of OAC. Conclusions In a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
KW - CHADS score
KW - CHADS-VASc score
KW - aspirin
KW - thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=84994351190&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2016.03.581
DO - 10.1016/j.jacc.2016.03.581
M3 - Article
C2 - 27339487
AN - SCOPUS:84994351190
SN - 0735-1097
VL - 67
SP - 2913
EP - 2923
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -