New Guidelines Call for 19% More AF Patients to be Treated With Anticoagulants

March 2, 2015—Based on an analysis from the Duke Clinical Research Institute (DCRI), new multisociety guidelines advise that nearly all women and people over 65 years of age in the United States with atrial fibrillation (AF) should receive oral anticoagulant therapy. The Duke study was published by Emily O’Brien, PhD, et al online ahead of print in Journal of the American Medical Association: Internal Medicine.

In its press release, DCRI noted that in 2014, the American Heart Association, American College of Cardiology, and Heart Rhythm Society issued broader guidelines for the use of anticoagulants in treating AF. Being female is now included in the guidelines as a contributing risk factor for stroke, advised Dr. O’Brien, lead investigator of the Duke study. The analysis provides a roadmap for how the broader guidelines could impact the number of patients recommended for drug therapy.

As summarized in the Duke announcement, analysts at DCRI reviewed data from the ORBIT registry that included 10,132 AF patients from 176 sites across the United States. They examined patients’ age, gender, and other risk factors, such as previous congestive heart failure, high blood pressure, diabetes, and previous stroke.

The investigators report that the overall proportion of AF patients recommended for oral anticoagulants would increase by 19% as a result of the new guidelines, from about 72% of all AF patients to 91%.

A similar increase was predicted for women with the heart condition. Under previous guidelines, approximately 77% of female AF patients in the study population would have been recommended for treatment with anticoagulants. Under the new guidelines, 98% of women in the sample population would have enough risk factors to be recommended for treatment.

The new recommendations also lower the age at which patients are considered at risk for stroke from 75 to 65. In the study population, this meant that almost 99% of patients with AF over age 65 could now be recommended for blood thinners, as compared with approximately 80% whose stroke risk was severe enough under the previous criteria to suggest drug therapy.

In the DCRI announcement, Dr. O’Brien commented, “The full adoption of the guidelines could reclassify nearly 1 million people with AF who previously weren’t recommended for treatment with blood thinners. What we don’t know yet is the extent to which doctors in community practice will incorporate the guidelines into their clinical routines, and what that will mean for the long-term outcomes for those patients. That will be the next step for our study.”

ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) is a national, prospective, outpatient disease registry to identify real-world treatment patterns of AF in the United States. More than 10,000 patients at 176 sites in the United States participate in the registry, which is supported by Janssen Pharmaceuticals, Inc. The new guidelines used the CHA2DS2-VASc refined stroke risk score, which identified the additional 19% of AF patients who are now recommended for oral anticoagulant therapy.