Patients with nonvalvular atrial fibrillation (AFib) who were not receiving oral anticoagulation were more likely to consider the therapy than their physicians, according to findings from the BOAT-AF study published April 24 in JAMA Network Open.

Christopher P. Cannon, MD, FACC, et al., enrolled 817 patients with nonvalvular AFib not receiving anticoagulation (median age,76; 45.2% women; median CHA₂DS₂-VASc score, 4) from 19 sites captured by the Veradigm Cardiology Registry (formerly ACC’s PINNACLE Registry) from Jan. 18, 2017 through May 7, 2018. Each patient completed a survey with the treating physician conducting a clinical review of their care to compare their perceptions of oral anticoagulation use. Anticoagulation appropriateness and patient willingness were assessed by a panel of four cardiologists.

Top reasons physicians provided for not prescribing anticoagulation included low AFib burden or successful rhythm control (34.0%), patient refusal (33.3%), perceived low risk of stroke (25.2%), fall risk (21.4%) and high bleeding risk (20.4%). Following the review, 27.1% of physicians said they would reconsider prescribing oral anticoagulation compared with 38.1% of patients, including 67 patients (24.6%) whose physician initially cited patient refusal.

Of patients deemed either “appropriate” or “may be appropriate” for anticoagulation (79.2%), physicians would reconsider the therapy for only 21.2% of patients, while 64.5% of patients indicated they would agree to start anticoagulation and another 27.3% were neutral. Follow-up at one year found that 14.6% of study patients were prescribed anticoagulation in comparison to 14.4% of similar patients at other centers captured by the registry.

The study authors acknowledge limitations such as the observational survey design and moderate sample size, noting their findings “suggest, but do not demonstrate, that shared decision-making would help improve rates of anticoagulation.”

“We identified a disconnect between the perceptions of physicians and patients and the treatment decision for anticoagulation, which suggests that a fresh discussion of the risks and benefits with shared decision-making may lead to more optimal treatment and better outcomes,” state the authors.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Risk Assessment, Registries, Cardiology, Anticoagulants, Hemorrhage, Stroke, Ships, Follow-Up Studies, Sample Size, Cardiologists, Atrial Fibrillation, PINNACLE Registry

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