International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation

Jorge Suarez, Jonathan P. Piccini, Li Liang, John J. Atherton, Christopher S. Hayward, Henry Krum, Gregg C. Fonarow, Renato D. Lopes, Adrian F. Hernandez

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe. Methods: The ADHERE-International registry enrolled patients with decompensated HF from 10 Asia Pacific and Latin American countries from December 2005 to January 2009. Rates of VKA use in patients with HF and either new-onset AF or a history of AF were determined and compared according to CHADS 2 scores. Multivariable logistic regression and hierarchical modeling with random effects for hospitals were used to determine clinical and regional factors associated with VKA use at discharge. Results: Among 9,706 admissions, there were 2,358 (24.3%) with prior AF and 674 (6.9%) with new-onset AF. The median age was 71 years (25th-75th percentiles 59-79) for prior AF and 69 (57-80) for new-onset AF patients. The overall rate of VKA use at discharge was 39.5%. Vitamin K antagonist use at discharge was 36.2% in patients with CHADS 2 scores ≥2 versus 50.2% in patients with CHADS 2 score equal to 1 (P <.0001). Vitamin K antagonist use was 36.4% in patients with hypertension, 28.1% in patients >75 years old, 34.8% in diabetics, and 44.4% in those with prior stroke/transient ischemic attack. After adjusting for patient characteristics, the highest and lowest rates of anticoagulation were in Australia (65.2%) and Taiwan (25.1%). Conclusion: International use of guidelines-recommended anticoagulation in HF patients with AF varies significantly across countries and represents an important opportunity for improving quality of care.

Original languageEnglish (US)
Pages (from-to)804-811
Number of pages8
JournalAmerican Heart Journal
Volume163
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Atrial Fibrillation
Heart Failure
Vitamin K
Quality of Health Care
Transient Ischemic Attack
Taiwan
Registries
Logistic Models
Stroke
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Suarez, J., Piccini, J. P., Liang, L., Atherton, J. J., Hayward, C. S., Krum, H., ... Hernandez, A. F. (2012). International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation. American Heart Journal, 163(5), 804-811. https://doi.org/10.1016/j.ahj.2012.02.008

International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation. / Suarez, Jorge; Piccini, Jonathan P.; Liang, Li; Atherton, John J.; Hayward, Christopher S.; Krum, Henry; Fonarow, Gregg C.; Lopes, Renato D.; Hernandez, Adrian F.

In: American Heart Journal, Vol. 163, No. 5, 01.05.2012, p. 804-811.

Research output: Contribution to journalArticle

Suarez, J, Piccini, JP, Liang, L, Atherton, JJ, Hayward, CS, Krum, H, Fonarow, GC, Lopes, RD & Hernandez, AF 2012, 'International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation', American Heart Journal, vol. 163, no. 5, pp. 804-811. https://doi.org/10.1016/j.ahj.2012.02.008
Suarez, Jorge ; Piccini, Jonathan P. ; Liang, Li ; Atherton, John J. ; Hayward, Christopher S. ; Krum, Henry ; Fonarow, Gregg C. ; Lopes, Renato D. ; Hernandez, Adrian F. / International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation. In: American Heart Journal. 2012 ; Vol. 163, No. 5. pp. 804-811.
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abstract = "Background: We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe. Methods: The ADHERE-International registry enrolled patients with decompensated HF from 10 Asia Pacific and Latin American countries from December 2005 to January 2009. Rates of VKA use in patients with HF and either new-onset AF or a history of AF were determined and compared according to CHADS 2 scores. Multivariable logistic regression and hierarchical modeling with random effects for hospitals were used to determine clinical and regional factors associated with VKA use at discharge. Results: Among 9,706 admissions, there were 2,358 (24.3{\%}) with prior AF and 674 (6.9{\%}) with new-onset AF. The median age was 71 years (25th-75th percentiles 59-79) for prior AF and 69 (57-80) for new-onset AF patients. The overall rate of VKA use at discharge was 39.5{\%}. Vitamin K antagonist use at discharge was 36.2{\%} in patients with CHADS 2 scores ≥2 versus 50.2{\%} in patients with CHADS 2 score equal to 1 (P <.0001). Vitamin K antagonist use was 36.4{\%} in patients with hypertension, 28.1{\%} in patients >75 years old, 34.8{\%} in diabetics, and 44.4{\%} in those with prior stroke/transient ischemic attack. After adjusting for patient characteristics, the highest and lowest rates of anticoagulation were in Australia (65.2{\%}) and Taiwan (25.1{\%}). Conclusion: International use of guidelines-recommended anticoagulation in HF patients with AF varies significantly across countries and represents an important opportunity for improving quality of care.",
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AU - Piccini, Jonathan P.

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AU - Hayward, Christopher S.

AU - Krum, Henry

AU - Fonarow, Gregg C.

AU - Lopes, Renato D.

AU - Hernandez, Adrian F.

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N2 - Background: We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe. Methods: The ADHERE-International registry enrolled patients with decompensated HF from 10 Asia Pacific and Latin American countries from December 2005 to January 2009. Rates of VKA use in patients with HF and either new-onset AF or a history of AF were determined and compared according to CHADS 2 scores. Multivariable logistic regression and hierarchical modeling with random effects for hospitals were used to determine clinical and regional factors associated with VKA use at discharge. Results: Among 9,706 admissions, there were 2,358 (24.3%) with prior AF and 674 (6.9%) with new-onset AF. The median age was 71 years (25th-75th percentiles 59-79) for prior AF and 69 (57-80) for new-onset AF patients. The overall rate of VKA use at discharge was 39.5%. Vitamin K antagonist use at discharge was 36.2% in patients with CHADS 2 scores ≥2 versus 50.2% in patients with CHADS 2 score equal to 1 (P <.0001). Vitamin K antagonist use was 36.4% in patients with hypertension, 28.1% in patients >75 years old, 34.8% in diabetics, and 44.4% in those with prior stroke/transient ischemic attack. After adjusting for patient characteristics, the highest and lowest rates of anticoagulation were in Australia (65.2%) and Taiwan (25.1%). Conclusion: International use of guidelines-recommended anticoagulation in HF patients with AF varies significantly across countries and represents an important opportunity for improving quality of care.

AB - Background: We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe. Methods: The ADHERE-International registry enrolled patients with decompensated HF from 10 Asia Pacific and Latin American countries from December 2005 to January 2009. Rates of VKA use in patients with HF and either new-onset AF or a history of AF were determined and compared according to CHADS 2 scores. Multivariable logistic regression and hierarchical modeling with random effects for hospitals were used to determine clinical and regional factors associated with VKA use at discharge. Results: Among 9,706 admissions, there were 2,358 (24.3%) with prior AF and 674 (6.9%) with new-onset AF. The median age was 71 years (25th-75th percentiles 59-79) for prior AF and 69 (57-80) for new-onset AF patients. The overall rate of VKA use at discharge was 39.5%. Vitamin K antagonist use at discharge was 36.2% in patients with CHADS 2 scores ≥2 versus 50.2% in patients with CHADS 2 score equal to 1 (P <.0001). Vitamin K antagonist use was 36.4% in patients with hypertension, 28.1% in patients >75 years old, 34.8% in diabetics, and 44.4% in those with prior stroke/transient ischemic attack. After adjusting for patient characteristics, the highest and lowest rates of anticoagulation were in Australia (65.2%) and Taiwan (25.1%). Conclusion: International use of guidelines-recommended anticoagulation in HF patients with AF varies significantly across countries and represents an important opportunity for improving quality of care.

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