Use of Evidence-Based Cardiac Prevention Therapy Among Outpatients With Atrial Fibrillation

Study Questions:

What are rates of evidence-based primary and secondary prevention cardiac therapy among patients with atrial fibrillation (AF) in the ambulatory setting?

Methods:

This was a retrospective analysis of baseline data on patients ≥18 years of age with electrocardiographically confirmed AF collected between June 2010 and August 2011, from 174 sites participating in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). The principal outcome measure was the use of evidence-based therapy among eligible patients (e.g., heart failure patients were eligible for a beta-blocker, an angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker if indicated, an aldosterone antagonist in the presence of New York Heart Association [NYHA] class III-IV symptoms, antihypertensive therapy if indicated, and implantable cardioverter-defibrillator in the presence of left ventricular ejection fraction ≤35% and NYHA class II-III symptoms).

Results:

Among 10,096 enrolled patients, 9,443 (93.5%) were eligible for one or more evidence-based therapies. Only 46.6% of eligible patients received all indicated therapies with fewer than one half of patients with coronary artery disease, diabetes mellitus, heart failure, and peripheral vascular disease receiving complete guideline-based care (25.1%, 43.2%, 42.5%, and 43.4%, respectively). Frailty, noncardiovascular comorbidities, current antiarrhythmic therapy, and geographic region were associated with not receiving indicated therapies.

Conclusions:

The authors concluded that evidence-based therapy for cardiovascular comorbid conditions is underused in the majority of AF patients.

Perspective:

The findings from this analysis draw attention to the majority of AF patients who are not receiving evidence-based primary and secondary prevention cardiac therapy in the ambulatory setting. The limitations of this analysis aside, these findings are a call to action to improve care for AF outpatients by improving evidence-based therapy in eligible patients.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Coronary Artery Disease, Defibrillators, Secondary Prevention, Outpatients, Warfarin, Heart Failure, Atrial Fibrillation, Diabetes Mellitus


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