Results of a large analysis suggest the latest guidelines for atrial fibrillation (AF) recommend anticoagulant therapy for nearly all women with AF and AF patients older than 65.
In 2014, the American Heart Association, American College of Cardiology, and Heart Rhythm Society issued broader guidelines for the use of anticoagulants in AF patients.
A group of researchers wanted to assess how these guidelines would change the use of anticoagulant therapy.
So they evaluated patients enrolled in the ORBIT-AF study, comparing how recommendations from the 2011 AF guidelines and the guidelines issued in 2014 would affect these patients.
Emily O’Brien, PhD, of the Duke Clinical Research Institute in Durham, North Carolina, and her colleagues conducted this research and described their findings in a letter to JAMA Internal Medicine.
The ORBIT-AF study included 10,132 AF patients from 176 sites across the US. Available data included patients’ age, gender, and risk factors such as prior congestive heart failure, high blood pressure, diabetes, and prior stroke.
The researchers found the overall proportion of AF patients recommended for anticoagulants increased from about 72% of patients with the 2011 guidelines to 91% with the newer guidelines.
A similar increase occurred for women with AF. Under the previous guidelines, anticoagulants would have been recommended for about 77% of female AF patients in the study population. Under the new guidelines, 98% of women in the sample population would have enough risk factors to qualify for treatment.
The 2014 guidelines also lower the age at which patients are considered at risk for stroke from 75 to 65.
In the study population, this meant that anticoagulant therapy would be recommended for almost 99% of patients with AF who were older than 65, compared to roughly 80% whose stroke risk was severe enough under the previous criteria.
“The full adoption of the guidelines could reclassify nearly 1 million people with AFib who previously weren’t recommended for treatment with blood thinners,” Dr O’Brien said.
“What we don’t know yet is the extent to which doctors in community practice will incorporate the guidelines into their clinical routines and what that will mean for the long-term outcomes for those patients. That will be the next step for our study.”
