Key result
Guideline-adherent OAC in CHA2DS2-VASc ≥2 links to ~59% lower 1-year death and stroke risk.
Why the study?
Contemporary management of atrial fibrillation across different medical specialities in primary and secondary care in the UK remained to be characterized.
Does guideline-adherent oral anticoagulation reduce death and stroke at 1 year in patients with recently diagnosed atrial fibrillation?
Cohort (n=1,595)
Yes
Does guideline-adherent oral anticoagulation reduce death and stroke at 1 year in patients with recently diagnosed atrial fibrillation?
Effect estimate: HR 0.41 (95% CI 0.24-0.70)
p-value: p=0.001
Guideline-adherent oral anticoagulation in recently diagnosed atrial fibrillation is associated with significant reductions in 1-year mortality and stroke risk in contemporary UK practice.
Supports guideline-adherent OAC in recent AF; extends observational data but leaves open randomized confirmation.
AIMS: This study established a prospective registry of contemporary management of UK patients with atrial fibrillation (AF) by cardiologists, general practitioners, and stroke, acute, and emergency medicine physicians at baseline and 1-year follow-up. METHODS AND RESULTS: Data on patients with recently diagnosed AF (≤12 months) were collected from medical records from 101 UK sites to permit comparison of patient characteristics and treatments between specialities. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. One thousand five hundred and ninety-five AF patients [mean (standard deviation) age 70.5 (11.2) years; 60.1% male; 97.4% white] were recruited in June 2017-June 2018 and followed up for 1 year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1 year, with non-vitamin K antagonist oral anticoagulants (NOACs) predominating (74.9 and 79.2% at baseline and 1 year, respectively). Vitamin K antagonist prescription was significantly higher in primary care, with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA2DS2-VASc ≥2) at baseline significantly reduced risk of death and stroke at 1 year [adjusted hazard ratio (95% confidence interval): 0.48 (0.27-0.84) and 0.11 (0.02-0.48), respectively]. Rhythm control is evident in ∼25%; only 1.6% received catheter ablation. CONCLUSION: High OAC use (>80%, mainly NOACs) rates varied by speciality, with VKA prescription higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in death and stroke at 1 year, regardless of speciality. Rhythm-control management is evident in only one-quarter despite AF symptoms reported in 56.6%. This registry extends the knowledge of contemporary AF management outside cardiology and demonstrates good implementation of clinical guidelines for the management of AF, particularly for stroke prevention.
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Shantsila et al. (2022) conducted a cohort in Atrial fibrillation (n=1,595). Guideline-adherent oral anticoagulation vs. No guideline-adherent oral anticoagulation was evaluated on Composite of death and stroke (HR 0.41, 95% CI 0.24-0.70, p=0.001). Guideline-adherent oral anticoagulation therapy at baseline in patients with a CHA2DS2-VASc score ≥2 significantly reduced the composite risk of death and stroke at 1 year (HR 0.41).
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