Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation.

Abstract

BACKGROUND:

Patients with atrial fibrillation often have cardiovascular risk factors or known comorbid disease, yet the use of evidence-based primary and secondary prevention cardiac therapy among atrial fibrillation outpatients is unknown.

METHODS:

Using baseline data collected between June 2010 and August 2011 from 174 sites participating in ORBIT-AF, a US national registry of patients with atrial fibrillation coordinated from Durham, NC, we examined professional guideline-recommended evidence-based therapy use for cardiovascular comorbid conditions and risk factors. Multivariable logistic regression was used to identify factors associated with receipt of all indicated evidence-based therapy.

RESULTS:

Among 10,096 enrolled patients, 93.5% were eligible for one or more evidence-based therapies. Among those eligible, 46.6% received all indicated therapies: 62.3% received an antiplatelet agent, 72.3% received a beta-blocker, 59.5% received an angiotensin-converting enzyme or angiotensin receptor blocker, 15.3% received an aldosterone antagonist, 65.7% received a statin, and 58.8% received an implantable cardioverter-defibrillator. A minority of patients with coronary artery disease, diabetes mellitus, heart failure, and peripheral vascular disease received all indicated therapies (25.1%, 43.2%, 42.5%, and 43.4%, respectively). A total of 52.4% of patients had controlled hypertension and 74.6% of patients with hyperlipidemia received a statin. Factors associated with nonreceipt of all indicated therapies included frailty, comorbid illness, geographic region, and antiarrhythmic drug therapy.

CONCLUSIONS:

The majority of eligible atrial fibrillation outpatients did not receive all guideline-recommended therapies for cardiovascular comorbid conditions and risk factors. This represents a potential opportunity to improve atrial fibrillation patients' quality of care and outcomes.

• Authors: Paul L Hess, Sunghee Kim, Jonathan P Piccini, Larry A Allen, Jack E Ansell, Paul Chang, James V Freeman, Bernard J Gersh, Peter R Kowey, Kenneth W Mahaffey, Laine Thomas, Eric D Peterson, Gregg C Fonarow
• Journal: The American journal of medicine (Am J Med) Vol. 126 Issue 7 Pg. 625-32.e1 (Jul 2013) ISSN: 1555-7162 [Electronic] United States
• PMID: 23787195 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Antihypertensive Agents
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Platelet Aggregation Inhibitors

Topics

• Aged
• Aged, 80 and over
• Antihypertensive Agents (therapeutic use)
• Atrial Fibrillation (therapy)
• Cardiovascular Diseases (prevention & control)
• Comorbidity
• Defibrillators, Implantable (statistics & numerical data)
• Evidence-Based Practice
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Logistic Models
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Practice Guidelines as Topic
• Registries
• Risk Factors