Clinical InvestigationTrends in antithrombotic therapy for atrial fibrillation: Data from the Veterans Health Administration Health System
Section snippets
Patients
Patients with a new episode of AF from October 1, 2001, through September 30, 2011, were identified in VA Outpatient Care Files and Inpatient Treatment Files using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code 427.31. There were 406,168 new AF episodes, defined as at least 2 encounters for AF within 120 days of each other and no AF-related encounters during the 12 months prior. To ensure complete diagnostic information during the prior
Results
The number of patients with new AF diagnoses increased, with new diagnoses increasing from 51,133 during the first year of observation (2002-2003) to 68,774 during the final year of observation (2010-2011). The median (interquartile range) CHADS2 remained unchanged at 2 (1-3). During the study period, the proportion of patients age ≥81 years increased from 23% to 30%, and those with renal disease increased from 7.9% to 14.1% (Table I).
In aggregate, 47% of patients received an OAC within 90 days
Discussion
This study showed a general decline in the rates of initiating OAC therapy from 2002 to 2011 among veterans with new AF. Patients with low stroke risk had significant decreases in OAC use, as hypothesized, but more than one-third of patients with a CHADS2 score of 0 still received an OAC in the final years of the study. Surprisingly, patients with higher risks for stroke also had significant declines in use of OAC therapy. This decline is concerning because patients with AF who fail to receive
Acknowledgements
This work was supported by a Mentored Career Enhancement Award in Patient Centered Outcomes Research for Mid-Career and Senior Investigators (K18) provided to Dr. Vaughan Sarrazin by the Agency for Healthcare Research and Quality, and by the Health Services Research and Development Service of the Department of Veterans Affairs. Dr Peter Cram is supported by a K24 award from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (AR062133). The authors do not have any
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