期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 67, 期 25, 页码 2913-2923出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2016.03.581
关键词
aspirin; CHADS(2) score; CHA(2)DS(2)-VASc score; thromboembolism
资金
- American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR)
- Bristol-Myers Squibb
- Pfizer Inc.
- Biotronik
- Biosense Webster
- National Institutes of Health (NIH)
- Doris Duke Charitable Foundation
- Veterans Affairs
- Gilead Sciences
- iRhythm
- Medtronic
- Janssen Pharmaceuticals
- SentreHeart
- NIH
- PCORI
- Pfizer
- Rhythm Diagnostic Systems
BACKGROUND Oral anticoagulation (OAC), rather than aspirin, is recommended in patients with atrial fibrillation (AF) at moderate to high risk of stroke. OBJECTIVES This study sought to examine patient and practice-level factors associated with prescription of aspirin alone compared with OAC in AF patients at intermediate to high stroke risk in real-world cardiology practices. METHODS The authors identified 2 cohorts of outpatients with AF and intermediate to high thromboembolic risk (CHADS2 score >= 2 and CHA(2)DS(2)-VASc >= 2) enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient and practice characteristics, the authors examined the prevalence and predictors of aspirin alone versus OAC prescription in AF patients at risk for stroke. RESULTS Of 210,380 identified patients with CHADS2 score >= 2 on antithrombotic therapy, 80,371 (38.2%) were treated with aspirin alone, and 130,009 (61.8%) were treated with warfarin or non-vitamin K antagonist OACs. In the cohort of 294,642 patients with CHA(2)DS(2)-VASc >= 2, 118,398 (40.2%) were treated with aspirin alone, and 176,244 (59.8%) were treated with warfarin or non-vitamin K antagonist OACs. After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were associated with prescription of aspirin only, whereas male sex, higher body mass index, prior stroke/transient ischemic attack, prior systemic embolism, and congestive heart failure were associated with more frequent prescription of OAC. CONCLUSIONS In a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC. (C) 2016 by the American College of Cardiology Foundation.
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