Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines: Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation)

Adam S. Barnett, Sunghee Kim, Gregg C. Fonarow, Laine E. Thomas, James A. Reiffel, Larry A. Allen, James V. Freeman, Gerald Naccarelli, Kenneth W. Mahaffey, Alan S. Go, Peter R. Kowey, Jack E. Ansell, Bernard J. Gersh, Elaine M. Hylek, Eric D. Peterson, Jonathan P. Piccini

Research output: Contribution to journalArticle

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Abstract

METHODS AND RESULTS: Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications. We also analyzed the association between GC care and clinical outcomes at both the patient level and center level. A total of 9570 patients were included. The median age was 75 years (interquartile range, 67-82), and the median CHA2DS2-VASc score was 4 (interquartile range, 3-5). A total of 5977 patients (62.5%) received care that was concordant with all guideline recommendations for which they were eligible. Rates of GC care were higher in patients treated by providers with greater specialization in arrhythmias (60.0%, 62.4%, and 67.0% for primary care physicians, cardiologists, and electrophysiologists, respectively; P<0.001). During a median of 30 months of follow-up, patients treated with GC care had a higher risk of bleeding hospitalization (hazard ratio=1.21; P=0.021) but a similar risk of death, stroke, major bleeding, and all-cause hospitalization.

CONCLUSIONS: Over a third of patients with atrial fibrillation in this large outpatient registry received care that differed in some respect from guideline recommendations. There was no apparent association between GC care and improved risk-adjusted outcomes.

BACKGROUND: It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes.

Original languageEnglish (US)
JournalCirculation. Arrhythmia and electrophysiology
Volume10
Issue number11
DOIs
StatePublished - Nov 1 2017

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Atrial Fibrillation
Registries
Guidelines
Therapeutics
Hospitalization
Hemorrhage
Primary Care Physicians
Cardiac Arrhythmias
Patient Care
Outpatients
Stroke

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Barnett, Adam S. ; Kim, Sunghee ; Fonarow, Gregg C. ; Thomas, Laine E. ; Reiffel, James A. ; Allen, Larry A. ; Freeman, James V. ; Naccarelli, Gerald ; Mahaffey, Kenneth W. ; Go, Alan S. ; Kowey, Peter R. ; Ansell, Jack E. ; Gersh, Bernard J. ; Hylek, Elaine M. ; Peterson, Eric D. ; Piccini, Jonathan P. / Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines : Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation). In: Circulation. Arrhythmia and electrophysiology. 2017 ; Vol. 10, No. 11.
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title = "Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines: Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation)",
abstract = "METHODS AND RESULTS: Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications. We also analyzed the association between GC care and clinical outcomes at both the patient level and center level. A total of 9570 patients were included. The median age was 75 years (interquartile range, 67-82), and the median CHA2DS2-VASc score was 4 (interquartile range, 3-5). A total of 5977 patients (62.5{\%}) received care that was concordant with all guideline recommendations for which they were eligible. Rates of GC care were higher in patients treated by providers with greater specialization in arrhythmias (60.0{\%}, 62.4{\%}, and 67.0{\%} for primary care physicians, cardiologists, and electrophysiologists, respectively; P<0.001). During a median of 30 months of follow-up, patients treated with GC care had a higher risk of bleeding hospitalization (hazard ratio=1.21; P=0.021) but a similar risk of death, stroke, major bleeding, and all-cause hospitalization.CONCLUSIONS: Over a third of patients with atrial fibrillation in this large outpatient registry received care that differed in some respect from guideline recommendations. There was no apparent association between GC care and improved risk-adjusted outcomes.BACKGROUND: It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes.",
author = "Barnett, {Adam S.} and Sunghee Kim and Fonarow, {Gregg C.} and Thomas, {Laine E.} and Reiffel, {James A.} and Allen, {Larry A.} and Freeman, {James V.} and Gerald Naccarelli and Mahaffey, {Kenneth W.} and Go, {Alan S.} and Kowey, {Peter R.} and Ansell, {Jack E.} and Gersh, {Bernard J.} and Hylek, {Elaine M.} and Peterson, {Eric D.} and Piccini, {Jonathan P.}",
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Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines : Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation). / Barnett, Adam S.; Kim, Sunghee; Fonarow, Gregg C.; Thomas, Laine E.; Reiffel, James A.; Allen, Larry A.; Freeman, James V.; Naccarelli, Gerald; Mahaffey, Kenneth W.; Go, Alan S.; Kowey, Peter R.; Ansell, Jack E.; Gersh, Bernard J.; Hylek, Elaine M.; Peterson, Eric D.; Piccini, Jonathan P.

In: Circulation. Arrhythmia and electrophysiology, Vol. 10, No. 11, 01.11.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment of Atrial Fibrillation and Concordance With the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines

T2 - Findings From ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation)

AU - Barnett, Adam S.

AU - Kim, Sunghee

AU - Fonarow, Gregg C.

AU - Thomas, Laine E.

AU - Reiffel, James A.

AU - Allen, Larry A.

AU - Freeman, James V.

AU - Naccarelli, Gerald

AU - Mahaffey, Kenneth W.

AU - Go, Alan S.

AU - Kowey, Peter R.

AU - Ansell, Jack E.

AU - Gersh, Bernard J.

AU - Hylek, Elaine M.

AU - Peterson, Eric D.

AU - Piccini, Jonathan P.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - METHODS AND RESULTS: Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications. We also analyzed the association between GC care and clinical outcomes at both the patient level and center level. A total of 9570 patients were included. The median age was 75 years (interquartile range, 67-82), and the median CHA2DS2-VASc score was 4 (interquartile range, 3-5). A total of 5977 patients (62.5%) received care that was concordant with all guideline recommendations for which they were eligible. Rates of GC care were higher in patients treated by providers with greater specialization in arrhythmias (60.0%, 62.4%, and 67.0% for primary care physicians, cardiologists, and electrophysiologists, respectively; P<0.001). During a median of 30 months of follow-up, patients treated with GC care had a higher risk of bleeding hospitalization (hazard ratio=1.21; P=0.021) but a similar risk of death, stroke, major bleeding, and all-cause hospitalization.CONCLUSIONS: Over a third of patients with atrial fibrillation in this large outpatient registry received care that differed in some respect from guideline recommendations. There was no apparent association between GC care and improved risk-adjusted outcomes.BACKGROUND: It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes.

AB - METHODS AND RESULTS: Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications. We also analyzed the association between GC care and clinical outcomes at both the patient level and center level. A total of 9570 patients were included. The median age was 75 years (interquartile range, 67-82), and the median CHA2DS2-VASc score was 4 (interquartile range, 3-5). A total of 5977 patients (62.5%) received care that was concordant with all guideline recommendations for which they were eligible. Rates of GC care were higher in patients treated by providers with greater specialization in arrhythmias (60.0%, 62.4%, and 67.0% for primary care physicians, cardiologists, and electrophysiologists, respectively; P<0.001). During a median of 30 months of follow-up, patients treated with GC care had a higher risk of bleeding hospitalization (hazard ratio=1.21; P=0.021) but a similar risk of death, stroke, major bleeding, and all-cause hospitalization.CONCLUSIONS: Over a third of patients with atrial fibrillation in this large outpatient registry received care that differed in some respect from guideline recommendations. There was no apparent association between GC care and improved risk-adjusted outcomes.BACKGROUND: It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes.

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DO - 10.1161/CIRCEP.117.005051

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