Contemporary Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Low to Moderate Risk of Stroke After Guideline-Recommended Change in Use of the CHADS2 to the CHA2DS2-VASc Score for Thromboembolic Risk Assessment Analysis From the National Cardiovascular Data Registry's Outpatient Practice Innovation and Clinical Excellence Atrial Fibrillation Registry
Contemporary Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Low to Moderate Risk of Stroke After Guideline-Recommended Change in Use of the CHADS2 to the CHA2DS2-VASc Score for Thromboembolic Risk Assessment Analysis From the National Cardiovascular Data Registry's Outpatient Practice Innovation and Clinical Excellence Atrial Fibrillation Registry
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DOI：
10.1161/circoutcomes.116.003476
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发表时间：
2017-05-01
影响因子：
6.9
通讯作者：
Hsu, Jonathan C.
中科院分区：
文献类型：
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作者：
Katz, David F.;Maddox, Thomas M.;Hsu, Jonathan C.
背景-2014年美国心脏协会/美国心脏病学会/心律学会房颤（AF）指南建议使用CHA（2）DS（2）-VASc评分代替CHADS（2）评分进行血栓栓塞风险分层和开始口服抗凝剂（OAC）。我们试图通过对CHADS（2）评分较低的患者应用CHA（2）DS（2）-VASc评分来确定在当代实践中有资格接受OAC治疗和接受OAC治疗的AF患者的比例。方法和结果-在美国心脏病学会国家心血管数据登记处的门诊实践创新和临床卓越登记处登记的AF患者中（2008-2014）CHADS（2）评分为0或1，我们计算了采用CHA（2）DS（2）-VASc评分对OAC适应症患者比例的影响。我们检查了总体OAC处方、直接OAC（达比加群/利伐沙班/阿哌沙班）处方的趋势，以及临床特征与OAC使用之间的多变量相关性。在346068例年龄为65 +/- 12岁的AF患者中，61%为男性，65%为白色。总的来说，CHADS（2）=0的患者中有24%和CHADS（2）=1的患者中有81%被重新分类为具有明确的OAC适应症（CHA（2）DS（2）-VASc评分>= 2）。在研究期间，OAC的使用从37%增加到48%，直接使用OAC的比例从5%增加到30%。增加CHA（2）DS（2）-VASc评分（比值比，2.07; 95%置信区间，4分对0分为1.97-2.19）和节律控制策略（优势比，1.34; 95%置信区间，结论-采用CHA（2）DS（2）-VASc评分可将64.5%的低CHADS（2）AF患者重新分类评分为OAC处方的I类适应症。2011年至2014年，OAC处方总体增加。
Background-Use of the CHA(2)DS(2)-VASc score instead of the CHADS(2) score for thromboembolic risk stratification and initiation of oral anticoagulation (OAC) was recommended in the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines. We sought to define the proportion of patients with AF qualifying for and receiving OAC in contemporary practice by applying the CHA(2)DS(2)-VASc score to patients with a low CHADS(2) score.Methods and Results-Among patients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's outpatient Practice Innovation and Clinical Excellence registry (2008-2014) CHADS(2) score of 0 or 1, we calculated the impact of adoption of the CHA(2)DS(2)-VASc score on the proportion of patients with an indication for OAC. We examined trends in prescription of OAC overall, direct OAC (dabigatran/rivaroxaban/apixaban), and multivariable associations between clinical characteristics and OAC use. Of 346 068 patients with AF aged 65 +/- 12 years, 61% were men and 65% were white. In total, 24% of those with CHADS(2)=0 and 81% of those with a CHADS(2)=1 were reclassified as having a definite indication for OAC (CHA(2)DS(2)-VASc score >= 2). OAC use increased from 37% to 48% during the study period, and direct OAC use increased from 5% to 30%. Increasing CHA(2)DS(2)-VASc score (odds ratio, 2.07; 95% confidence interval, 1.97-2.19 for score of 4 versus 0) and rhythm control strategy (odds ratio, 1.34; 95% confidence interval, 1.30-1.39) were associated with increased OAC use.Conclusions-Adoption of the CHA(2)DS(2)-VASc score reclassifies 64.5% of patients with AF with low CHADS(2) scores into a class I indication for OAC prescription. Overall OAC prescription increased between 2011 and 2014.