Electrophysiologist visits for incident atrial fibrillation were associated with increased oral anticoagulation rates and significantly lower stroke risk (HR 0.63) in patients aged ≥80 years.
Does an electrophysiologist visit improve guideline-concordant treatment and clinical outcomes in adult patients with incident atrial fibrillation?
Electrophysiologist consultation for incident atrial fibrillation is associated with higher rates of guideline-concordant therapy and reduced stroke risk, particularly in older patients, despite this demographic being less likely to receive such consultation.
Tasa de eventos absoluta: 0% vs 0%
Background Care pathways for patients with atrial fibrillation (AF) are poorly understood and may influence the likelihood of guideline concordant oral anticoagulation or antiarrhythmic drug therapy and associated outcomes. Methods Adult patients in the Optum Clinformatics Database (2015–2023) with incident AF were identified. Care pathways, by treating clinician specialty (primary care, cardiology, electrophysiology) during each AF‐related visit in the 1 year post diagnosis were examined. Cox regression models were used to assess associations between an electrophysiologist visit and AF‐related treatments including antiarrhythmic drug therapy and oral anticoagulation and outcomes including AF‐related hospitalizations, heart failure hospitalizations, and stroke. Results Of the 37 370 patients included, 7700 (20.6%) had a care pathway including an electrophysiologist visit. Older patients (70–79 and 80+ versus 18–49 years: hazard ratio HR, 0.71 95% CI, 0.64–0.78 and HR, 0.57 95% CI, 0.51–0.63, respectively) and those with a higher CHA 2 DS 2 ‐VASc score (2–3 and ≥4 versus 0–1: HR, 0.79 95% CI, 0.74–0.85 and HR, 0.76 95% CI, 0.68–0.84, respectively) were less likely to have an electrophysiologist visit. Electrophysiologist visits were associated with a significant increase in rates of treatment with antiarrhythmic drug and oral anticoagulation. Patients aged ≥80 years with an electrophysiologist visit had significantly lower risks of stroke compared with those without an electrophysiologist visit (HR, 0.63 95% CI, 0.42–0.95). Conclusions Certain demographic groups including older patients had lesser likelihood of electrophysiologist consultation, but guideline concordant care was more likely associated with electrophysiology care pathways. Electrophysiology care pathways were associated with improved outcomes especially among the groups with greatest stroke risk.
Zeitler et al. (Tue,) reported a other. Electrophysiologist visits for incident atrial fibrillation were associated with increased oral anticoagulation rates and significantly lower stroke risk (HR 0.63) in patients aged ≥80 years.