TY - JOUR
T1 - Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation
T2 - Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry
AU - O'Brien, Emily C.
AU - Holmes, Dajuanicia N.
AU - Ansell, Jack E.
AU - Allen, Larry A.
AU - Hylek, Elaine
AU - Kowey, Peter R.
AU - Gersh, Bernard J.
AU - Fonarow, Gregg C.
AU - Koller, Christopher R.
AU - Ezekowitz, Michael D.
AU - Mahaffey, Kenneth W.
AU - Chang, Paul
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
AU - Singer, Daniel E.
N1 - Funding Information:
The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ. This project was supported (in part) by funding from the Agency of Healthcare Research and Quality through cooperative agreement number 1U19 HS021092. Dr. Singer was, in part, supported by the Eliot B. and Edith C. Shoolman fund of the Massachusetts General Hospital (Boston, MA).
PY - 2014/4
Y1 - 2014/4
N2 - Background Oral anticoagulation (OAC) therapy reduces the risk of thromboembolic events associated with atrial fibrillation (AF), yet a substantial proportion of patients with AF are not prescribed OAC. The aim of this study is to describe the frequencies of and factors associated with OAC contraindications in contemporary clinical practice. Methods We analyzed data from the ORBIT-AF study, a national, prospective, outpatient registry of incident and prevalent AF. Oral anticoagulation contraindications were uniformly collected at enrollment by site personnel using a predefined list. Baseline patient and provider characteristics were compared between participants with and without documented OAC contraindications. Results From June 2010 to August 2011, 10,130 patients 18 years or older with electrocardiographically documented AF were enrolled at 176 practices. Of these, 1,330 (13.1%) had contraindications documented at the baseline visit: prior bleed (27.7%), patient refusal/preference (27.5%), high bleeding risk (18.0%), frequent falls/frailty (17.6%), need for dual antiplatelet therapy (10.4%), unable to adhere/monitor warfarin (6.0%), comorbid illness (5.3%), prior intracranial hemorrhage (5.0%), allergy (2.4%), occupational risk (0.8%), pregnancy (0.2%), and other (12.6%). Among patients with reported contraindications, 30.3% were taking warfarin or dabigatran, as compared with 83.0% of those without reported contraindications. Besides "patient refusal/preference," being labeled as having frequent falls or being frail was associated with the lowest OAC use among patients with high stroke risk. Conclusions Contraindications to OAC therapy among patients with AF are common but subjective. Many patients with reported contraindications were receiving OAC, suggesting that the perceived benefit outweighed the potential harm posed by the relative contraindication.
AB - Background Oral anticoagulation (OAC) therapy reduces the risk of thromboembolic events associated with atrial fibrillation (AF), yet a substantial proportion of patients with AF are not prescribed OAC. The aim of this study is to describe the frequencies of and factors associated with OAC contraindications in contemporary clinical practice. Methods We analyzed data from the ORBIT-AF study, a national, prospective, outpatient registry of incident and prevalent AF. Oral anticoagulation contraindications were uniformly collected at enrollment by site personnel using a predefined list. Baseline patient and provider characteristics were compared between participants with and without documented OAC contraindications. Results From June 2010 to August 2011, 10,130 patients 18 years or older with electrocardiographically documented AF were enrolled at 176 practices. Of these, 1,330 (13.1%) had contraindications documented at the baseline visit: prior bleed (27.7%), patient refusal/preference (27.5%), high bleeding risk (18.0%), frequent falls/frailty (17.6%), need for dual antiplatelet therapy (10.4%), unable to adhere/monitor warfarin (6.0%), comorbid illness (5.3%), prior intracranial hemorrhage (5.0%), allergy (2.4%), occupational risk (0.8%), pregnancy (0.2%), and other (12.6%). Among patients with reported contraindications, 30.3% were taking warfarin or dabigatran, as compared with 83.0% of those without reported contraindications. Besides "patient refusal/preference," being labeled as having frequent falls or being frail was associated with the lowest OAC use among patients with high stroke risk. Conclusions Contraindications to OAC therapy among patients with AF are common but subjective. Many patients with reported contraindications were receiving OAC, suggesting that the perceived benefit outweighed the potential harm posed by the relative contraindication.
UR - http://www.scopus.com/inward/record.url?scp=84897080301&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84897080301&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2013.12.014
DO - 10.1016/j.ahj.2013.12.014
M3 - Article
C2 - 24655711
AN - SCOPUS:84897080301
SN - 0002-8703
VL - 167
SP - 601-609.e1
JO - American heart journal
JF - American heart journal
IS - 4
ER -