News | Pharmaceuticals | March 17, 2016

Atrial Fibrillation Patients at Highest Stroke Risk Not Prescribed Necessary Medication

Study finds major gap in treatment protocols

atrial fibrillation patients, high stroke risk, not prescribed medication, JAMA Cardiology study

March 17, 2016 — Nearly half of all atrial fibrillation (AF) patients at the highest risk for stroke are not being prescribed blood thinners by their cardiologists, according to a new study. The study, published online March 16 in JAMA Cardiology, was conducted by researchers at University of California, San Diego School of Medicine and University of California, San Francisco.

The four-year study, which involved more than 400,000 participants, found that as stroke risk factor scores generally increased, cardiologists were more likely to prescribe blood thinners, but AF patients with the highest risk for stroke were not prescribed oral anticoagulants as frequently as guidelines suggested.

“Despite a well-known association of AF with stroke, we found a significant lack of oral anticoagulant prescribed to reduce blood clots in high-risk patients. This is a wake-up call,” said lead author Jonathan C. Hsu, M.D., cardiologist and assistant clinical professor of medicine at UC San Diego School of Medicine. “As the number of stroke cases in AF patients increase annually in the United States, our findings draw attention to a treatment gap in a demographic who may need these therapies the most.”

The incidence of stroke for AF patients is up to seven times greater than in those without the condition. Cardioembolic stroke is one of the main complications of AF, when stagnant blood in the left atrium of the heart forms a blood clot and is released into the circulation where it blocks flow to an organ, often the brain.

In AF, electrical impulses in the upper chambers of the heart are chaotic and the atrial walls quiver rather than contract normally in moving blood to the lower chambers. As a result, blood clots may form. One in four adults over age 40 is at risk for AF with a projection of nearly 6 million people in the nation having the condition by 2050.

Standardized recommendations are used to determine and help quantify an AF patient’s stroke risk and help treating physicians determine whether a prescription of oral medication, such as warfarin or newer blood thinners, may be warranted. However, in this study, researchers found just under half (48 percent) of AF patients at the highest risk for stroke were not prescribed treatment.

“Well-informed and well-intended cardiologists may struggle with a lack of data regarding optimizing risks versus benefits in patients with indications for anti-platelet drugs for their coronary artery disease and additional anticoagulants for their atrial fibrillation,” said senior author Gregory Marcus, M.D., cardiologist and endowed professor in AF research at UC San Francisco School of Medicine. “However, while studies specifically addressing those challenging cases are needed, it is clear that identifying barriers to anticoagulant prescription, whether they involve physician education or enhanced patient access, will be the key to rectifying the situation.”

The authors said there are likely multiple reasons behind the practice, including the perceived risk of prescribing blood thinners in sicker patients.

“Physicians may be avoiding additional therapy in certain patients taking antiplatelet medications because of the increased risk of bleeding associated with the oral anticoagulants,” said Hsu. “It may be thought of as too dangerous for these sicker patients, but we still know that in most of these patients the benefits of blood thinning to reduce the risk of stroke outweigh the risks of bleeding.”

Co-authors include Thomas M. Maddox, M.D., MSc, VA Eastern Colorado Health Care System, Colorado Cardiovascular Outcomes Research Consortium, and University of Colorado School of Medicine; Kevin Kennedy, MS, Saint Luke’s Mid America Heart Institute; David F. Katz, M.D., and Lucas N. Marzec, M.D., University of Colorado School of Medicine; Steven A. Lubitz, M.D., MPH, Massachusetts General Hospital; Anil K. Gehi, M.D., The University of North Carolina at Chapel Hill; and Mintu P. Turakhia, M.D., MAS, VA Palo Alto Health Care System/Stanford University School of Medicine.

This research was funded, in part, by the American College of Cardiology National Cardiovascular Data Registry.

For more information: www.cardiology.jamanetwork.com

Related Content

An example of the new generation of cardiac monitoring device that is replacing Holter monitoring is the Cardea Solo wearable sensor. The FDA-cleared device automatically analyzes data when the device is turned back into the physician's office and automatically produces a draft summary report. This technology can simplify the workflow by eliminating the need for third-party involvement.

Feature | Atrial Fibrillation | September 13, 2018
Rapid advances in technology to monitor atrial fibrillation (AF or Afib) are enabling clinicians to access real-time
Atrial Fibrillation Patients Diagnosed With Carotid Atery Disease Face Increased Risk of Dementia

Image courtesy of Intermountain Medical Center Heart Institute

News | Atrial Fibrillation | May 24, 2018
Atrial fibrillation patients who are diagnosed with carotid artery disease face higher risks for developing dementia,...
Botulinum Toxin (botox) Injection in CABG Patients Reduces AFib After Cardiac Surgery. #HRS2018

Figure 1: At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3 percent in the botox group, as compared to 50 percent in the placebo group

News | Atrial Fibrillation | May 18, 2018
 
Atrial fibrillation ablation using the Abbott Ensite electro mapping system. CABANA Trial Confirms Ablation Equal To or Superior to Drug Therapy. #HRS2018

Atrial fibrillation ablation using the Abbott Ensite electro mapping system.

Feature | Atrial Fibrillation | May 17, 2018
May 16, 2018 – The first results of the randomized, multicenter, long-term, international...
Link Found Between Post-Traumatic Stress, Increased Risk of AFib. #HRS2018
News | Atrial Fibrillation | May 15, 2018
May 15, 2018 — A new study is the first to report a relationship between post-traumatic stress disorder (PTSD) and ne
Marijuana Use Does Not Increase Risk of Arrhythmias, Might Reduce AFib Risk. #HRS2018
News | Atrial Fibrillation | May 15, 2018
May 15, 2018 — According to new research, smoking marijuana may not be associated with an increased risk of ventricul
First Results Reported from AVIATOR 2 Registry for AFib Patients Undergoing PCI.

Photo courtesy of the American Heart Association

News | Atrial Fibrillation | May 15, 2018
May 15, 2018 – Results of the AVIATOR 2 international registry data show a discrepancy between physician perception a
New Combined Risk Score More Effectively Predicts Stroke Risk in AFib Patients

Image courtesy of Intermountain Medical Center Heart Institute

News | Atrial Fibrillation | May 11, 2018
A new study finds that integrating two separate clinical risk score models more accurately helps clinicians assess the...
Depression Linked to Increased Atrial Fibrillation Risk
News | Atrial Fibrillation | March 27, 2018
March 27, 2018 — Depression may increase the risk for...
Overlay Init