Key result
Pre-hospital OACs linked to ~46% lower risk of in-hospital ischemic stroke or TIA in AF.
Why the study?
Oral anticoagulants prevent stroke and improve survival in AF, but problems in their utilization among hospitalized AF patients in China needed identification.
What is the rate of guideline-recommended oral anti-coagulant use and its association with stroke risk among hospitalized patients with non-valvular atrial fibrillation in China?
Observational (n=52,530)
Yes
What is the rate of guideline-recommended oral anti-coagulant use and its association with stroke risk among hospitalized patients with non-valvular atrial fibrillation in China?
Odds Ratio: 0.54 (95% CI 0.43–0.68)
Absolute Event Rate: 1.4% vs 2.2%
p-value: p=<0.001
Despite significant underutilization of oral anticoagulants in Chinese hospitalized patients with atrial fibrillation, OAC use is associated with a reduced risk of ischemic stroke and utilization rates are improving over time.
Persistent OAC gaps in Chinese AF inpatients warrant attention; extends registry data and leaves open impact of targeted quality initiatives.
BACKGROUND: Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS: Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS: A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001). CONCLUSIONS: In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.
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Lin et al. (2023) conducted an observational in Non-valvular atrial fibrillation (n=52,530). Pre-hospital oral anti-coagulants (OAC) vs. No pre-hospital OAC was evaluated on In-hospital new-onset ischemic stroke or TIA (OR 0.54, 95% CI 0.43-0.68, p=<0.001). Pre-hospital use of oral anticoagulants was associated with a significantly lower risk of in-hospital new-onset ischemic stroke or transient ischemic attack (adjusted OR 0.54) among Chinese patients with atrial fibrillation.
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