Evaluation of practice patterns in the treatment of atrial fibrillation among the commercially insured

Abstract

Debate continues regarding whether the preferred management of most patients with AF is through rate control or restoration of normal sinus rhythm. Our retrospective study found that treatments to restore normal heart rhythm, including LACA, which could be considered aggressive initial treatment, were typically reserved as second- or third-line alternatives. Initial standard of care for the majority patients was beta blockers. Though use of anticoagulation may be higher than other observational studies, opportunities exist to increase treatment in high risk patients.

Stroke and Bleeding Risk Associated With Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation in Clinical Practice

“…This study revealed that 52.4% of NVAF patients with CHADS 2 ≥1 did not receive any antithrombotic therapy or were only on aspirin therapy. Interestingly, these percentages were consistent with higher CHADS 2 groups (52.6% for CHADS 2 ≥2, 55.3% for CHADS 2 ≥3), which has also been suggested by other observational studies . However, an increasing trend of warfarin use was observed over the study period; 28.2% of the incident NVAF patients initiated warfarin during 2006–2008 and 36.0% in 2009–2011.…”

“…Interestingly, these percentages were consistent with higher CHADS 2 groups (52.6% for CHADS 2 ≥2, 55.3% for CHADS 2 ≥3), which has also been suggested by other observational studies. 6 However, an increasing trend of warfarin use was observed over the study period; 28.2% of the incident NVAF patients initiated warfarin during 2006-2008 and 36.0% in 2009-2011. This trend may be associated with the introduction of new guidelines calling for use of the CHADS 2 score to determine warfarin use.…”

“…The quality of antithrombotic therapy (either anticoagulant or antiplatelet) during routine medical care is often suboptimal. Previous studies showed that 30% to 40% of those at high risk for stroke fail to receive recommended anticoagulant therapy and even after they start on warfarin therapy, ≈30% of patients discontinued their warfarin within 1 year . Also, the quality of warfarin therapy is often suboptimal; the average of time in therapeutic range (TTR) of INR values ranged from 51% to 63% based on the management setting in the United States …”

Atrial Fibrillation in Heart Failure US Ambulatory Cardiology Practices and the Potential for Uptake of Catheter Ablation: An National Cardiovascular Data Registry (NCDR ® ) Research to Practice (R2P) Project

“…Previous studies have described practice patterns of rate and rhythm control for the treatment of AF alone 13, 14. Similar to our findings, rate control therapies were consistently utilized more frequently than rhythm control strategies.…”

“…Similar to our findings, rate control therapies were consistently utilized more frequently than rhythm control strategies. Furthermore, DCCV and AADs were employed more often than catheter ablation, which, in 1 contemporary cohort of AF patients, accounted for 5.2% of all AF therapies and 11% of rhythm control treatments . The only study to describe AF management in an HF cohort was a retrospective, single‐center study by Al‐Khatib et al .…”