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Many with AF qualify for oral anticoagulation therapy under new guidelines
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Most patients with atrial fibrillation not recommended for oral anticoagulation under previous guidelines are now eligible for therapy based on the newest guidelines, according to a report published in JAMA Internal Medicine.
Now, almost all women and all adults aged 65 years and older with AF are recommended to receive oral anticoagulation, based on the 2014 guidelines for the treatment of AF issued by the American Heart Association, American College of Cardiology and Heart Rhythm Society.
Researchers compared the proportion of patients with AF enrolled in the ORBIT-AF registry (n = 10,132; median age, 75 years; 42.3% women) recommended for oral anticoagulation under the 2011 and 2014 guidelines. They identified patients with a definitive recommendation for oral anticoagulation therapy: CHADS2 score 2 or higher under the 2011 guidelines and CHA2DS2-VASc score 2 or higher under the 2014 guidelines.
Overall, the proportion of patients recommended for oral anticoagulation increased by 19%, from 71.8% under the 2011 guidelines to 90.8% under the 2014 guidelines (P < .001). Approximately two-thirds of those not recommended for oral anticoagulation under the 2011 guidelines are now recommended to receive oral anticoagulation, the researchers wrote.
For patients younger than 65 years, the proportion recommended for oral anticoagulation increased from 43.1% under the 2011 guidelines to 60.6% under the 2014 guidelines. The proportion of adults aged 65 years and older recommended for oral anticoagulation increased from 79.1% to 98.5% in patients aged 65 years or older and the proportion of women recommended for anticoagulation increased from 76.7% to 97.7%, according to the results.
Among the 1,926 patients newly recommended for oral anticoagulation, 43.6% were reclassified because of one risk factor, 49.5% because of two risk factors and 6.9% because of three risk factors, the researchers wrote. Common reasons for reclassification included age (81.4%), female sex (46.8%) and vascular disease (35.1%).
The researchers concluded that if the stroke risk distribution in ORBIT-AF is representative of the broader U.S. population with AF, full adoption of the 2014 guidelines would mean that 988,500 patients would be newly reclassified as recommended for oral anticoagulation.
“What we don’t know yet is the extent to which doctors in community practice will incorporate the guidelines into their clinical routines, and what that will mean for the long-term outcomes for those patients,” Emily C. O’Brien, PhD, from Duke Clinical Research Institute, said in a press release. “That will be the next step for our study.”
According to the researchers, the increase is due to adoption of the CHA2DS2-VASc score in the 2014 guideline, “which was created to better identify patients with AF with truly low risk of stroke by incorporating information on female sex, younger age and vascular disease.” – by Erik Swain
Disclosures: The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, and two researchers receive research support from Janssen as principal investigators for the registry. The researchers report financial ties with Boston Scientific, Eli Lilly, Forest Laboratories, Janssen Pharmaceuticals, Medtronic, Modest, Ortho-McNeil Pharmaceutical and Portola Pharmaceuticals.
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