PINNACLE Registry Study Highlights Concerns About Number of Low-Risk AFib Patients Receiving Oral Anticoagulants

Despite atrial fibrillation (AFib) guidelines stating that patients younger than 60 years with AFib but without any established risk for stroke should not be prescribed oral anticoagulants, nearly 25 percent of this population is receiving these medications, according to a research letter published April 13 in the JAMA Internal Medicine.

Using data from the ACC’s PINNACLE Registry, researchers looked at records from 10,995 young, healthy patients with AFib with no structural heart disease and at low risk for thromboembolism. The records were from 76 cardiology practices from 287 different geographic offices in 33 states.

Investigators divided the patients into two cohorts: a cohort of patients with a CHADS2 (defined as one point each for congestive heart failure, hypertension, age ≥75 years, and diabetes mellitus, and two points for prior stroke, transient ischemic attack, or thromboembolism) score of 0, and a cohort of those with a CHA2DS2-VASc (defined as one point each for congestive heart failure, hypertension, age 65-74 years, diabetes mellitus, vascular disease, and female sex, and two points each for prior stroke, transient ischemic attack, or thromboembolism and age ≥75 years) score of 0, each considered low risk for stroke based on contemporary guidelines.

Results showed that 2,561 patients (23.3 percent) in the first cohort and 1,787 patients (26.6 percent) patients in the second cohort were prescribed oral anticoagulants by cardiologists. Overall, 25 percent of young, healthy patients at the lowest risk for stroke were being treated with anticoagulation therapy. The authors note that this number is “contrary to contemporary guideline recommendations.” 

The analysis also revealed that “in both the cohort of patients with a CHADS2 score of 0 and the cohort of those with a CHA2DS2-VASc score of 0,” patients with AFib who were prescribed oral anticoagulants were older and more frequently insured by Medicare or were uninsured, and had a higher body mass index. Further, a greater proportion of patients from the Northeast received this treatment than those from the South.

“These findings may have important public health implications since young and healthy patients with AFib who are the lowest risk of stroke have an unfavorable risk-benefit profile when prescribed oral anticoagulants,” said Jonathan C. Hsu, MD, FACC, assistant clinical professor of medicine, cardiology and cardiac electrophysiology at the University of California, San Diego, CA, and the study’s lead author. “Health care professionals may not be fully aware of the potential risks associated with oral anticoagulation or the particularly low risk of stroke in this population.”

Keywords: Anticoagulants, Atrial Fibrillation, Diabetes Mellitus, Electrophysiologic Techniques, Cardiac, Heart Failure, Hypertension, Ischemic Attack, Transient, Medically Uninsured, Medicare, Public Health, Registries, Risk Assessment, Stroke, Thromboembolism

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