Log in to MyACC
Lack of Concordance Between Empirical Scores and Physician Assessments of Stroke and Bleeding Risk in Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry
Study Questions:
How closely does physician assessment of stroke and bleeding risk coincide with formal risk scores in patients with atrial fibrillation (AF)?
Methods:
The data for this study were obtained from a multicenter registry of 10,094 outpatients with AF (ORBIT-AF Registry). CHADS2 and ATRIA scores were calculated. CHADS2 scores of 0, 1, and ≥2 were categorized as low, intermediate, and high risk for stroke, respectively. ATRIA scores of 0-3, 4, and ≥5 were categorized as low, intermediate, and high risk of bleeding on anticoagulation therapy. Physicians were asked to subjectively classify patients into low-risk (<3%), intermediate-risk (3-6%), or high-risk (>6%) subgroups for stroke and bleeding complications.
Results:
The CHADS2 score identified 72% of patients as high-risk for stroke, compared to only 16% based on physician assessment. The ATRIA score indicated a high risk of bleeding in 17% of patients, compared to 7% based on physician assessment. Compared to the CHADS2 score, physician-assigned stroke risk was less influenced by hypertension, heart failure, and diabetes. Approximately 80% of patients deemed to be at high risk for stroke based either on the CHADS2 score or physician assessment were treated with an anticoagulant.
Conclusions:
The authors concluded that physicians often underestimate the risk of stroke in patients with AF.
Perspective:
Several studies have demonstrated the underutilization of anticoagulation therapy in high-risk patients with AF. The introduction of new anticoagulants that eliminate many of the problems associated with warfarin has had little impact on the underutilization. This study indicates that a major reason for underutilization of anticoagulants could be a failure of physicians to accurately identify high-risk patients.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension
Keywords: Stroke, Warfarin, Heart Failure, Atrial Fibrillation, Hypertension, Hemorrhage, Diabetes Mellitus, ACC Annual Scientific Session
< Back to Listings
