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?


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).


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.


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


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, Atherosclerotic Disease (CAD/PAD), 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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