Temporal Trends in Medication Use and Outcomes in Atrial Fibrillation

Pilote, Louise; Eisenberg, Mark J.; Essebag, Vidal; Tu, Jack V.; Humphries, Karin H.; Yinko, Sylvie S.L. Leung; Behlouli, Hassan; Guo, Helen; Jackevicius, Cynthia A.

doi:10.1016/j.cjca.2012.09.021

Cited by 33 publications

(25 citation statements)

References 32 publications

(29 reference statements)

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“…6,9,13,16,30,37,38 Treatment management varies according to local practice and recommendations from national guidelines, possibly explaining the difference between the high anticoagulation rates observed in this Canadian study and those reported in other countries. 6,9,13,16,30,37,38 Introduction of the new oral anticoagulants to the Canadian market in 2011 and our observation that 21% of octogenarians were using these agents at the time of this study could also explain the rise in anticoagulant use. Clinicians may be proceeding cautiously to prescribe the new oral anticoagulants to vulnerable patients with multiple comorbidities, because participants in clinical trials may not be representative of the real-life frail older population and experience is still limited.…”

Section: Discussioncontrasting

confidence: 65%

The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study

Lefebvre

St‐Onge

Glazer-Cavanagh

et al. 2016

Canadian Journal of Cardiology

102

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Section: Discussioncontrasting

confidence: 65%

The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study

Lefebvre

St‐Onge

Glazer-Cavanagh

et al. 2016

Canadian Journal of Cardiology

102

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“…Earlier analyses of practice patterns have found clinicians largely follow guidelines, with initial therapy consisting of pharmacological agents for rate [7][8][9] or rhythm control 10 . However, more recently, left atrial catheter ablation (LACA) is gaining in popularity, with the number of first-time procedures doubling in a 3 year span 11 despite the fact that LACA is invasive and associated with complications including stroke, transient ischemic attack, and, in rare cases, death [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Sylwestrzak

Barron

et al. 2014

Current Medical Research and Opinion

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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.

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“…24,25 In brief, we identified patients with a primary or secondary diagnosis of AF according to the International Classification of Diseases, 9th/10th revision codes (427.3, 427.31, or 427.32 / I48) with the use of the following hospital discharge abstract databases in Quebec and Ontario: Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière and the Canadian Institute for Health Information Discharge Abstract Database, respectively. The primary (principal) diagnosis code is the main condition treated or investigated during the admission.…”

Section: Study Population and Data Sourcesmentioning

confidence: 99%

Warfarin Use and the Risk for Stroke and Bleeding in Patients With Atrial Fibrillation Undergoing Dialysis

et al. 2014

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Editorial see p 1190 Clinical Perspective on p 1203CKD is also considered as an independent risk factor for bleeding, and, therefore, warfarin use in patients who have severe CKD could increase the risk for bleeding. 2 Moreover, in patients with AF undergoing hemodialysis, it is routine practice to administer heparin, which could also increase the risk for bleeding. 15Current observational studies on warfarin use and the risk for stroke and bleeding in patients with AF undergoing dialysis present conflicting results. 1,8,16,17 Globally, because of a lack of evidence from randomized, controlled trials, AF Background-Current observational studies on warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation (AF) undergoing dialysis found conflicting results. Methods and Results-We conducted a population-based retrospective cohort study of patients aged ≥65 years admitted to a hospital with a primary or secondary diagnosis of AF, in Quebec and Ontario, Canada from 1998 to 2007. The AF cohort was grouped into dialysis (hemodialysis and peritoneal dialysis) and nondialysis patients and into warfarin and no-warfarin users according to the first prescription filled for warfarin within 30 days after AF hospital discharge. We determined the association between warfarin use and the risk for stroke and bleeding in dialysis and nondialysis patients. The cohort comprised 1626 dialysis patients and 204 210 nondialysis patients. Among dialysis patients, 46% (756/1626) patients were prescribed warfarin. Among dialysis patients, warfarin users had more congestive heart failure and diabetes mellitus, but fewer prior bleeding events in comparison with the no-warfarin users. Among dialysis patients, warfarin use, in comparison with no-warfarin use, was not associated with a lower risk for stroke (adjusted hazard ratio, 1.14; 95% confidence interval, 0.78-1.67) but was associated with a 44% higher risk for bleeding (adjusted hazard ratio, 1.44; 95% confidence interval, 1.13-1.85) after adjusting for potential confounders. Propensity score-adjusted analyses yielded similar results. Conclusions-Our results suggest that warfarin use is not beneficial in reducing stroke risk, but it is associated with a higher bleeding risk in patients with AF undergoing dialysis.

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Temporal Trends in Medication Use and Outcomes in Atrial Fibrillation

Cited by 33 publications

References 32 publications

The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study

The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study

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

Warfarin Use and the Risk for Stroke and Bleeding in Patients With Atrial Fibrillation Undergoing Dialysis

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