Predictors of Anticoagulant Treatment in Patients With Nonvalvular Atrial Fibrillation

Abstract

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Real life anticoagulation treatment of patients with atrial fibrillation in Germany: extent and causes of anticoagulant under-use

“…On the other hand, the presence of a vascular disease increased the OAC underuse risk in our study. A similar pattern was reported in an earlier study that showed that heart failure was correlated to an under-average OAC use [34].…”

“…This may lead to the decision not to use OAC in AF patients. We also confirm the observation of previous studies that a diagnosis of paroxysmal AF is related to less OAC use [18,34,37]. Whereas guidelines do not differ between types of AF in terms of OAC usage recommendations, treating physicians obviously still see OAC as treatment for patients with more frequent/permanent AF.…”

“…Whereas guidelines do not differ between types of AF in terms of OAC usage recommendations, treating physicians obviously still see OAC as treatment for patients with more frequent/permanent AF. Finally, as expected and known from previous studies, a history of stroke increases the probability that an AF patient receives OAC [34].…”

“…In line with previous data, older female patients faced a higher OAC under-use risk in our sample [16,19,34,35]. However, we cannot confirm that adherence of AF patients' influences the OAC usage rate as was shown in other studies [15,36].…”

“…That may ease the necessary INR value management associated with a VKA-based OAC. We also identified congestive heart failure, diabetes, and hypertension as factors decreasing the probability of OAC under-use; the latter was reported by an earlier study as well [34]. Treating physicians may see these diseases as additional stroke risk factors that increase the OAC need.…”