More than half of patients with atrial fibrillation do not receive guideline-based therapy
In a rural health system, more than half of patients with atrial fibrillation did not receive treatment consistent with guidance from the American Heart Association, American College of Cardiology and Heart Rhythm Society, data show.
These societies recommend oral anticoagulants for patients with a CHA2DS2-VASc (congestive heart failure, hypertension, age greater than 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score of two or higher, Johan Diaz, a medical student at Geisinger School of Medicine in Scranton, Pennsylvania, and colleagues wrote.
According to the researchers, previous reports showed that 20% to 60% of eligible patients do not receive oral anticoagulants, but there is limited evidence on the risk factors for undertreatment. Therefore, they retrospectively reviewed data from 1,062 patients (47.6% men; median age, 75.5 years) who were diagnosed with atrial fibrillation and then later experienced an ischemic stroke.
Diaz and colleagues reported in the Journal of the Neurological Sciences that 52.4% of the 1,015 patients with CHA2DS2-VASc scores of two or higher were undertreated. In addition, the median time from atrial fibrillation diagnosis to index stroke was significantly lower among undertreated patients (1.9 vs. 3.6 years).
A history of other thromboembolism — excluding stroke, transient ischemic attack and myocardial infarction — (OR = 0.41), the number of patient encounters annually (OR = 0.9), and the median time between atrial fibrillation diagnosis and stroke event (OR = 0.86) were negatively associated with undertreatment, according to the researchers.
A Kaplan-Meier estimator revealed lower 1-year survival probability from the stroke index date among patients who were undertreated (68.6%) vs. those receiving guideline-based treatment (71.2%), but the researchers said this finding was not significant. However, a Cox-hazard model indicated that age (HR = 1.05) and a history of congestive heart failure (HR = 1.88) were associated with an increased risk for mortality.
The findings are “consistent with previous observations,” Ramin Zand, MD, a neurologist at Geisinger Health System in Scranton, Pennsylvania, and a study co-author, told Healio Primary Care. He said that a multidisciplinary approach to care would likely improve atrial fibrillation management.
“Closing the gap requires a collaboration between different specialties, including pharmacists, cardiologists, neurologists, PCPs, etc.,” Zand told Healio Primary Care. “Patients should also be involved in this process” through shared decision-making.