Use of oral anticoagulants in atrial fibrillation is highly variable and only weakly associated with estimated stroke risk: Cross-sectional population database study

References

• Stewart S HC, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 2001;86:516–21.
   PubMed Web of Science ®Google Scholar
• Miyasaka YM, Barnes BJ, Gersh, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114:119–25.
   PubMed Web of Science ®Google Scholar
• Go AS HE,Phillips KA,Chang Y,Henault LE,Selby JV,Singer DE. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) Study. J Am Med Assoc. 2001;285:2370–5.
   Google Scholar
• Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation. Europace 2010;12:1360–420.
   PubMed Web of Science ®Google Scholar
• van Walraven C, Hart RG, Connolly S, Austin PC, Mant J, Hobbs FDR, et al. Effect of age on stroke prevention therapy in patients with atrial fibrillation. Stroke 2009;40:1410–6.
   PubMed Web of Science ®Google Scholar
• Hart RG, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857–67.
   PubMed Web of Science ®Google Scholar
• Thomson R, Parkin D, Eccles M, Sudlow M, Robinson A. Decision analysis and guidelines for anticoagulant therapy to prevent stroke in patients with atrial fibrillation. Lancet 2000; 355:956–62.
   PubMed Web of Science ®Google Scholar
• Jowett S, Bryan S, Mant J, Fletcher K, Roalfe A, Fitzmaurice D, et al. Cost effectiveness of warfarin versus aspirin in patients older than 75 years with atrial fibrillation. Stroke 2011;42: 1717–21.
   PubMed Web of Science ®Google Scholar
• Ogilvie IM, Welner SA, Cowell W, Lip GY. Ischaemic stroke and bleeding rates in ‘real-world’ atrial fibrillation patients. J Thromb Haemost. 2011;106:34–44.
   Google Scholar
• National Institute for Health and Clinical Excellence. Atrial fibrillation: National clinical guideline for management in primary and secondary care. London: NICE; 2006.
   Google Scholar
• Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2008;133 (6 Suppl):546–92.
   PubMedGoogle Scholar
• Ogilvie IM, Newton N, Welner S. Underuse of oral anticoagulants in atrial fibrillation: A systematic review. Am J Med. 2010:638–45.
   Google Scholar
• Holt TA, Hunter TD, Gunnarsson C, Khan N, Cload P, Lip GYH. Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey. Brit J Gen Pract. 2012;62:710–17.
   PubMed Web of Science ®Google Scholar
• Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: Results from the national registry of atrial fibrillation. J Am Med Assoc. 2001;285:2864–70.
   PubMed Web of Science ®Google Scholar
• Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. American College of Cardiology Foundation/American Heart Association Task Force on guidelines for the management of patients with atrial fibrillation: A report of the 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 practice guidelines. Circulation 2011;123:e269–e367.
   PubMedGoogle Scholar
• Borman NL, Kalra PA, Kalra PR. Acute kidney injury in patients with decompensated heart failure. Brit J Hosp Med. 2010;71: 269–75.
   Google Scholar
• British Medical Association and NHS Employers. Quality and outcomes framework for 2012/13. Guidance for PCOs and practices (p118). Available at http://www.nhsemployers.org/Aboutus/Publications/Documents/QOF_2012-13.pdf (accessed 12 November 2013).
   Google Scholar
• Gorin L, Fauchier L, Nonin E, de Labriolle A, Haguenoer K, Cosnay P, et al. Antithrombotic treatment and the risk of death and stroke in patients with atrial fibrillation and a CHADS2 score = 1. J Thromb Haemost. 2010;103:833–40.
   Google Scholar
• Lip GYH. Anticoagulation therapy and the risk of stroke in patients with atrial fibrillation at ‘moderate risk’ [CHADS2 score = 1]: Simplifying stroke risk assessment and thromboprophylaxis in real-life clinical practice. J Thromb Haemost. 2010;103:683–5.
   Google Scholar
• Karthikeyan G, Eikelboom JW. The CHADS2 score for stroke risk stratification in atrial fibrillation—friend or foe? J Thromb Haemost. 2010;104:45–8.
   Google Scholar
• Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL, et al. Antithrombotic therapy in atrial fibrillation. Chest 2008;133:546S–92S.
   Google Scholar
• Van Staa TP, Setakis E, Di Tanna GL, Lane DA, Lip GYH. A comparison of risk stratification schemes for stroke in 79 884 atrial fibrillation patients in general practice. J Thromb Haemost. 2011;9:39–48.
   PubMed Web of Science ®Google Scholar
• Elder R, Kirkpatrick M, Ramsay W, MacLeod M, Guthrie B, Sutton M, et al. Measuring quality in primary medical services using data from SPICE. Edinburgh: Information and Statistics Division, NHS National Services Scotland; 2007.
   Google Scholar
• NHS England: Primary Care Commissioning. QOF implementation: Business rules. Available at http://www.pcc.nhs.uk/145 (accessed 12 November 2013).
   Google Scholar
• Carstairs V, Morris R. Deprivation and health in Scotland. Aberdeen: Aberdeen University Press; 1991.
   Google Scholar
• Guthrie B, Clark SA, McCowan C. The burden of psychotropic drug prescribing in people with dementia: A population database study. Age Ageing 2010;39:637–42.
   PubMed Web of Science ®Google Scholar
• Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: Cross sectional population database analysis in Scottish general practice. Br Med J. 2011;342:d3514.
   Google Scholar
• Dreischulte T, Grant A, McCowan C, McAnaw J, Guthrie B. Quality and safety of medication use in primary care: Consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement. Br Med C Clin Pharmacol. 2012;12:5.
   Google Scholar
• Larsen K, Merlo J. Appropriate assessment of neighbourhood effects on individual health: Integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2007; 161:81–8.
   Google Scholar
• Lip G, Huber K, Andreotti F, Arnesen H, Airaksinen J, Cuisset T, et al. Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing coronary stenting: Executive summary—a consensus document of the European Society of Cardiology working group on thrombosis, endorsed by the European Heart Rhythm Association (EHRA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2010;31: 1311–8.
   PubMed Web of Science ®Google Scholar
• Hansen ML, Sorensen R, Mette T, Fog-Petersen M, Raunsø J, Gadsbøll N, et al. Less is more. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;16: 170–5.
   Google Scholar
• Lip GYH, Andreotti F, Fauchier L, Huber K, Hylek E, Knight E, et al. Bleeding risk assessment and management in atrial fibrillation patients: A position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace 2011;13:723–46.
   PubMed Web of Science ®Google Scholar
• Pugh D, Pugh J, Mead GE. Attitudes of physicians regarding anticoagulation for atrial fibrillation: A systematic review. Age Ageing 2011;40:675–83.
   PubMed Web of Science ®Google Scholar
• Nieuwlaat R, Capucci A, Lip GY, Olsson SB, Prins MH, Nieman FH, et al. Antithrombotic treatment in real-life atrial fibrillation patients: A report from the Euro Heart Survey on atrial fibrillation. Eur Heart J. 2006;27:3018–26.
   PubMed Web of Science ®Google Scholar
• Gallagher AM RS, Plumb J, van Staa TP. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: Do the appropriate patients receive stroke prophylaxis? J Thromb Haemost. 2008;6:1500–6.
   PubMedGoogle Scholar
• NHS improvement. Guidance on risk assessment and stroke prevention for atrial fibrillation (GRASP-AF). Available at http://www.improvement.nhs.uk/graspaf/ (accessed 27 February 2013).
   Google Scholar
• Mant J, Hobbs FR, Fletcher K, Roalfe A, Fitzmaurice D, Lip GYH, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet 2007;370:493–503.
   PubMed Web of Science ®Google Scholar
• National Institute for Health and Clinical Excellence. Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation. NICE Technology appraisal guidance 256. Available at http://www.nice.org.uk/nicemedia/live/13746/59295/59295.pdf (accessed 12 November 2013).
   Google Scholar
• Scottish Medicines Consortium (SMC) No. (852/13). Rivaroxaban 15 and 20 mg film-coated tablets. Available at http://www.scottishmedicines.org.uk/files/advice/rivaroxaban_Xarelto_for_AF_FINAL_Jan_2012_for_website.pdf (accessed 12 November 2013).
   Google Scholar
• Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010;138:1093–100.
   PubMed Web of Science ®Google Scholar
• Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage—results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151:713–9.
   PubMed Web of Science ®Google Scholar
• Hohnloser SH. Stroke prevention versus bleeding risk in atrial fibrillation—a clinical dilemma. J Am Coll Cardiol. 2011;57: 181–3.
   PubMedGoogle Scholar
• Pamukcu B, Lip GYH, Lane DA. Simplifying stroke risk stratification in atrial fibrillation patients: Implications of the CHA2DS2-VASc risk stratification scores. Age Ageing 2010: afq059.
   PubMedGoogle Scholar