Outpatients with atrial fibrillation (AFib) may be more likely to be prescribed an oral anticoagulant (OAC) as their number of stroke risk factors increase. However, less than half of high-risk patients at the highest ranges of stroke risk are prescribed an OAC, according to a study published March 16 in JAMA Cardiology.

Jonathan C. Hsu, MD, MAS, FACC, and colleagues looked at 429,417 outpatients with AFib enrolled in ACC's PINNACLE Registry between January 2008 and December 2012. The researchers calculated the CHADS₂ score and the CHA₂DS₂-VASc score for all patients, and examined the association between increased stroke risk score and prescription of an OAC.

Results showed that prescribed treatment consisted of an OAC (44.9 percent of patients), aspirin only (25.9 percent), aspirin plus a thienopyridine (5.5 percent), or no antithrombotic therapy (23.8 percent). Each 1-point increase in risk score was associated with increased odds of OAC prescription compared with aspirin-only prescription. However, a plateau of OAC prescription was observed as OAC prescription prevalence did not exceed 50 percent even in higher-risk patients with a CHADS₂ score exceeding 3 or a CHA₂DS₂-VASc score exceeding 4.

“These findings draw attention to important gaps in appropriate treatment of patients with AFib at the highest risk of stroke and highlight opportunities to understand the reasons behind these gaps and insights to improve them,” the authors conclude.

In an accompanying commentary, Jonathan P. Piccini Sr., MD, MHS, FACC, and Gregg C. Fonarow, MD, FACC, note that the study highlights an opportunity to improve care among outpatient practices. “It is now critical to move beyond documenting these quality gaps to implementing meaningful and effective quality improvement,” they add. 

Keywords: Anticoagulants, Aspirin, Atrial Fibrillation, Attention, Fibrinolytic Agents, Outpatients, Prevalence, Quality Improvement, Risk Factors, Stroke, Thienopyridines, PINNACLE Registry, National Cardiovascular Data Registries

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