Clinical InvestigationElectrophysiologyPhysician practices regarding contraindications to oral anticoagulation in atrial fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry
Section snippets
Study population
We used data from the ORBIT-AF study. The study design and population of ORBIT-AF have been described in detail.8 Briefly, ORBIT-AF is a national, prospective registry to improve the quality of care and outcomes for patients with AF. Eligible patients 18 years and older who were able to provide informed consent and follow-up information were consecutively enrolled at 176 sites nationwide. Participating sites were selected to be geographically representative and to include a diverse set of
Results
Of the 10,130 patients enrolled in ORBIT-AF, 1,330 (13.1%) had contraindications to OAC. Table I shows the distribution of specific OAC contraindications among ORBIT-AF patients who listed a contraindication. Overall, the most commonly reported contraindications were patient refusal and prior bleed, both of which were listed for more than one-quarter of contraindicated patients. Other commonly listed contraindications were high bleeding risk (18.0%), frequent falls/frailty (17.6%), other
Discussion
Proper use of anticoagulation is vital to reducing stroke risk among patients with AF, yet OAC is substantially underused in clinical practice.4, 13, 14 We examined patterns of OAC contraindication and associated baseline factors in a large contemporary outpatient population of AF. Our major findings are as follows: (1) 13.1% of patients in our study population had a documented contraindication to OAC at baseline; (2) patients with perceived contraindications were, on average, older, sicker,
Disclosures
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).
This work was performed at the Duke Clinical Research Institute, Durham, NC.
Dr. O’Brien and Ms. Holmes report no disclosures. Dr.
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Left Atrial Appendage Occlusion—A Choice or a Last Resort? How to Approach the Patient
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2022, Heart RhythmCitation Excerpt :Much of the published data on barriers to OAC therapy has mainly focused on the provider perspective and during a time when warfarin was the primary stroke prophylactic therapy.14–16 In the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, patient refusal and prior bleed were the two most common reasons for documented contraindications to OAC therapy.14 In our survey, we asked providers to rank the importance of barriers to guideline-directed OAC therapy in their practice and similarly found prior bleeding and risk of bleeding most important.
Left Atrial Appendage Occlusion—A Choice or a Last Resort? How to Approach the Patient
2022, Interventional Cardiology Clinics
William G. Stevenson, MD, served as guest editor for this article.