Early adoption of dabigatran and its dosing in US patients with atrial fibrillation: results from the outcomes registry for better informed treatment of atrial fibrillation.
Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators and PatientsShow More
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BACKGROUND: Dabigatran is a novel oral anticoagulant approved for thromboprophylaxis in atrial fibrillation. Adoption patterns of this new agent in community practice are unknown. METHODS AND RESULTS: We studied patterns of dabigatran use among patients enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry between June 2010 and August 2011 and followed for 12 months. Among 9974 atrial fibrillation patients included, 1217 (12%) were treated with dabigatran during the study. Overall, patients receiving dabigatran were younger (median age 72 versus 75 years, P<0.0001), more likely to be white (92% versus 89%, P=0.005), more likely to have private insurance (33% versus 25%, P<0.0001), and less likely to have prior cardiovascular disease (4% versus 33%, P<0.0001). They had more new-onset atrial fibrillation (8.8% versus 4.1%, P<0.0001), lower CHADS2 scores (estimated risk based on the presence of congestive heart failure, hypertension, aged ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack; mean 2.0 versus 2.3, P<0.0001), and lower Anticoagulation and Risk Factors in Atrial Fibrillation scores (mean 2.4 versus 2.8, P<0.0001). More than half (n=14/25, 56%) of patients with severe kidney disease were not prescribed reduced dosing, whereas 10% (n=91/920) with preserved renal function received lower dosing. Among patients not on dabigatran at baseline, 8% had dabigatran initiated during follow-up. Patient education was significantly associated with switching from warfarin to dabigatran (adjusted odds ratio for postgraduate 1.73, P=0.007), whereas antiarrhythmic drug use significantly correlated with de novo adoption of dabigatran (adjusted odds ratio 2.4, P<0.0001). CONCLUSIONS: Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. CLINICAL TRIAL REGISTRATION URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Aged, 80 and over
Drug Dosage Calculations
Health Knowledge, Attitudes, Practice
Patient Education as Topic
Practice Patterns, Physicians'
Proportional Hazards Models
Published Version (Please cite this version)10.1161/JAHA.113.000535
Publication InfoAnsell, J; Chang, P; Ezekowitz, MD; Fonarow, GC; Gersh, Bernard John; Holmes, DaJuanicia; ... Thomas, Laine Elliott (2013). Early adoption of dabigatran and its dosing in US patients with atrial fibrillation: results from the outcomes registry for better informed treatment of atrial fibrillation. J Am Heart Assoc, 2(6). pp. e000535. 10.1161/JAHA.113.000535. Retrieved from http://hdl.handle.net/10161/15012.
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Adjunct Professor in the Department of Medicine
Fred Cobb, M.D. Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical Research Institute (DCRI), Durham, NC, USA. Dr Peterson is the Principal Investigator of the National Institute of Health, Lung and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also the Principal I
Associate Professor of Medicine
Jonathan P. Piccini, MD, MHS is a clinical cardiac electrophysiologist and Associate Professor of Medicine at Duke University Medical Center and the Duke Clinical Research Institute. His research interests include the conduct of clinical trials and the assessment of cardiovascular therapeutics for the care of patients with heart rhythm disorders. At present, he is the Director of the EP Clinical Trials Program and Arrhythmia Core Laboratory at Duke University. He also serves on the Clinical W
Associate Professor of Biostatistics and Bioinformatics
Measurement error, longitudinal data, joint modeling
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Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation (AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF). Chang, P; Fonarow, GC; Gersh, Bernard John; Holmqvist, Fredrik Nils; Hylek, E; Kim, S; Kowey, Peter R; ... (15 authors) (J Am Heart Assoc, 2015-09-14)BACKGROUND: Most patients with atrial fibrillation (AF) require rate control; however, the optimal target heart rate remains under debate. We aimed to assess rate control and subsequent outcomes among patients with permanent ...
Racial differences in the prevalence and outcomes of atrial fibrillation among patients hospitalized with heart failure. Fonarow, GC; Get With the Guidelines Steering Committee and Hospitals; Hernandez, Adrian Felipe; Liang, L; Peterson, Eric David; Piccini, Jonathan Paul Sr; Thomas, Kevin Lindsey; ... (8 authors) (J Am Heart Assoc, 2013-09-26)BACKGROUND: The intersection of heart failure (HF) and atrial fibrillation (AF) is common, but the burden of AF among black patients with HF is poorly characterized. We sought to determine the prevalence of AF, characteristics, ...
Ansell, JE; Chang, P; Fonarow, GC; Gersh, Bernard John; Hylek, EM; Kowey, Peter R; Mahaffey, Kenneth William; ... (13 authors) (Eur Heart J, 2015-12-07)BACKGROUND: Therapeutic decisions in atrial fibrillation (AF) are often influenced by assessment of bleeding risk. However, existing bleeding risk scores have limitations. OBJECTIVES: We sought to develop and validate a ...