Key result
Withholding OACs in non-valvular AF leaves ~96% undertreated, driven by the paroxysmal subtype.
Why the study?
Although oral anticoagulants reduce stroke risk in atrial fibrillation based on the CHA2DS2-VASc score, not all high-risk patients receive treatment.
Cross-Sectional (n=784)
Physicians frequently base the decision to prescribe oral anticoagulants on the subtype of atrial fibrillation (e.g., paroxysmal) rather than the objective CHA2DS2-VASc stroke risk score, leading to significant undertreatment.
Undertreatment of non-valvular AF may reflect prioritization of paroxysmal subtype over CHA2DS2-VASc; leaves open whether education improves risk-based prescribing.
Background: Atrial fibrillation is a major health problem due to the stroke risk associated with it. To reduce stroke risk, oral anticoagulants (OAC) are prescribed using the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes Mellitus; Stroke; Vascular disease; Age 65–74 years; Sex category) risk score, a clinical probability assessment that includes a combination of risk factors predicting the probability of a stroke. Not all patients with high risk are receiving this treatment. The aim of this study was to assess physician adherence to clinical guidelines concerning the OAC treatment and to identify the factors that were associated with the decision to prescribe it. Methods: Registry data from 784 patients with non-valvular atrial fibrillation were evaluated in this retrospective cross-sectional study. Demographic data, subtype of AF, comorbidities associated with higher stroke and bleeding risk, and antithrombotic treatment received were recorded. We compared stroke and bleeding risk in patients with and without OAC treatment to determine if the clinicians followed guidelines: prescribed when necessary and abstained when not needed. Results: OAC treatment was administered in 617 (78.7%) patients. Of the 167 patients who did not receive OAC, 161 (96.4%) were undertreated according to their risk score, as opposed to those who received OAC in which the percentage of overtreated was 3.2%. Most undertreated patients (60.5%, p < 0.001) were with paroxysmal atrial fibrillation subtype. Conclusions: The decision to use anticoagulants for stroke prevention was based on the type of atrial fibrillation, rather than on the risk of stroke as quantified by CHA2DS2-VASc as per the recommended guidelines.
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Vesa et al. (2020) conducted a cross-sectional in non-valvular atrial fibrillation (n=784). Oral anticoagulants (OAC) vs. No OAC treatment was evaluated on Undertreatment according to CHA2DS2-VASc risk score among patients not receiving OAC. Among patients with non-valvular atrial fibrillation, 96.4% of those not receiving oral anticoagulants were undertreated, with omission driven by paroxysmal AF subtype (60.5%, P<0.001).
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