TY - JOUR
T1 - Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation
AU - Hess, Paul L.
AU - Kim, Sunghee
AU - Piccini, Jonathan P.
AU - Allen, Larry A.
AU - Ansell, Jack E.
AU - Chang, Paul
AU - Freeman, James V.
AU - Gersh, Bernard J.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Thomas, Laine
AU - Peterson, Eric D.
AU - Fonarow, Gregg C.
N1 - Funding Information:
Funding: Primary funding was provided by Ortho-McNeil Janssen Scientific Affairs, LLC . PLH was funded by NIH T-32 training grant HL069749-09 .
Funding Information:
Conflicts of Interest: PLH, none. SK, none. JPP, Johnson & Johnson, Bayer Healthcare, and Boston-Scientific, research grants; Johnson & Johnson, Forest Laboratories, and Sanofi-Aventis , consulting fees/honoraria. LAA, none. JEA, Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, Janssen, and Boehringer Ingelheim, consulting fees/honoraria. PC, Johnson & Johnson, employed. JVF, none. BJG, none. PRK, none. KWM, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Momenta Pharmaceuticals, Novartis, Portola, Pozen, Regado Biotechnologies, Sanofi-Aventis, Schering-Plough, and the Medicines Company, research grants; AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson Pharmaceutical Research and Development, Merck, Novartis, Ortho/MacNeil, Pfizer, PolyMedix, Sanofi-Aventis, Schering-Plough , consulting fees/honoraria. LT, none. EDP, Eli Lilly & Company and Johnson & Johnson Pharmaceutical Research and Development, research grants. GCF, Medtronic, consulting fees/honoraria.
PY - 2013/7
Y1 - 2013/7
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Evidence-based medicine
KW - Registry
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U2 - 10.1016/j.amjmed.2013.01.037
DO - 10.1016/j.amjmed.2013.01.037
M3 - Article
C2 - 23787195
AN - SCOPUS:84879154641
SN - 0002-9343
VL - 126
SP - 625-632.e1
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -