Older Age and Hypertension Associated with More Oral Anticoagulant Use in Patients with Atrial Fibrillation

MARCH 16, 2016
Andrew Smith
Analysis of cardiovascular registry data comparing components of the CHA2DS2-VASc score and oral anticoagulant use found that women and patients with vascular disease were less likely than other patients with atrial fibrillation (AFib) to be prescribed anticoagulation that is now indicated by standard guidelines.
Investigators tabulated data from 706,308 patients who visited cardiologists between 2010 and 2014, comparing actual anticoagulant prescriptions to the current recommendation of anticoagulation for all patients who score 2 or higher on the CHA2DS2-VASc scale.
The patients included in the study all had CHA2DS2-VASc scores of 2 or higher, so anticoagulation would now be indicated across the board, but the analysis found that patients with certain risk factors were significantly more likely to receive treatment than patients with other risk factors.
After adjustment for demographics, known risk factors, modified HAS-BLED scores and other variables, women and vascular disease patients were less likely than average to receive anticoagulation. Female sex was associated with a 0.79 odds ratio [OR] of treatment (95% confidence interval [CI], 0.78 to 0.80; p < 0.001), while a history of vascular disease was associated with 0.91 OR of treatment (95% CI, 0.85 to 0.96; p = 0.001).
Higher-than-average odds of treatment were associated with all other risk factors included in the CHA2DS2-VASc scale: hypertension (OR, 2.57; 95% CI, 2.46 to 2.69, p < 0.001), age 65 to 74 (OR, 3.35; 95% CI, 3.20 to 3.51; p < 0.001), age 75+ (OR, 3.36; 95% CI, 3.21 to 3.52; p < 0.001), congestive heart failure (OR, 1.31; 95% CI, 1.29 to 1.33; p < 0.001), type 2 diabetes (OR, 1.17; 95% CI, 1.15 to 1.18; p < 0.001) and stroke or transient ischemic attack (OR, 1.32; 95% CI, 1.28 to 1.36; p < 0.001).

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