Background: Use of the CHADS-VASc score instead of the CHADS 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 CHADS-VASc score to patients with a low CHADS 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 score of 0 or 1, we calculated the impact of adoption of the CHADS-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=0 and 81% of those with a CHADS=1 were reclassified as having a definite indication for OAC (CHADS-VASc score ≥2). OAC use increased from 37% to 48% during the study period, and direct OAC use increased from 5% to 30%. Increasing CHADS-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 CHADS-VASc score reclassifies 64.5% of patients with AF with low CHADS scores into a class I indication for OAC prescription. Overall OAC prescription increased between 2011 and 2014.
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| http://dx.doi.org/10.1161/CIRCOUTCOMES.116.003476 | DOI Listing |
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