Abstract
Background
Patients with paroxysmal and persistent atrial fibrillation experience a similar risk
of thromboembolism. Therefore, consensus guidelines recommend anticoagulant therapy
in those at risk for thromboembolism irrespective of atrial fibrillation classification.
We sought to examine whether there are differences in rates of appropriate oral anticoagulant
treatment among patients with paroxysmal vs persistent atrial fibrillation in real-world
cardiology practices.
Methods
We studied 71,316 outpatients with atrial fibrillation and intermediate to high thromboembolic
risk (CHADS2 score ≥2) enrolled in the American College of Cardiology PINNACLE Registry between
2008 and 2012. Using hierarchical modified Poisson regression models adjusted for
patient characteristics, we examined whether anticoagulant treatment rates differed
between patients with paroxysmal vs persistent atrial fibrillation.
Results
The majority of outpatients (78.4%, n = 55,905) had paroxysmal atrial fibrillation.
In both unadjusted and multivariable adjusted analyses, patients with paroxysmal atrial
fibrillation were less frequently prescribed oral anticoagulant therapy than those
with persistent atrial fibrillation (50.3% vs 64.2%; adjusted risk ratio [RR] 0.74;
95% confidence interval [CI], 0.72-0.76). Instead, patients with paroxysmal atrial
fibrillation were prescribed more frequently only antiplatelet therapy (35.1% vs 25.0%;
adjusted RR 1.77; 95% CI, 1.69-1.86) or neither antiplatelet nor anticoagulant therapy
(14.6% vs 10.8%; adjusted RR 1.35; 95% CI, 1.26-1.44; P < .0001 for differences across all 3 comparisons).
Conclusions
In a large, real-world cardiac outpatient population, patients with paroxysmal atrial
fibrillation with a moderate to high risk of stroke were less likely to be prescribed
appropriate oral anticoagulant therapy and more likely to be prescribed less effective
or no therapy for thromboembolism prevention.
Keywords
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Article info
Publication history
Published online: December 29, 2014
Footnotes
Funding: This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR). The views expressed in this manuscript represent those of the authors, and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com. PINNACLE Registry is an initiative of the American College of Cardiology Foundation. Bristol-Myers Squibb and Pfizer Inc. are Founding Sponsors of the PINNACLE Registry.
Conflicts of Interest: PSC reports support by a Career Development Grant Award (K23HL102224) from the National Heart Lung and Blood Institute. TMM reports support by a Health Services Research and Development career development award from the US Department of Veterans Affairs. GMM reports research support from Medtronic, Baylis Medical, Gilead, and SentreHeart Inc.
Authorship: All authors had access to the data, and all either wrote portions of the manuscript or edited it.
Identification
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
