Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA2DS2-VASc Scores: Findings From the ORBIT-AF I and II Registries.
Abstract
Background Current American College of Cardiology/American Heart Association guidelines
suggest that for patients with atrial fibrillation who are at low risk for stroke
(CHA2DS2VASc=1) (or women with CHA2DS2VASc=2) a variety of treatment strategies may
be considered. However, in clinical practice, patterns of treatment in these "low-risk"
patients are not well described. The objective of this analysis is to define thromboembolic
event rates and to describe treatment patterns in patients with low-risk CHA2DS2VASc
scores. Methods and Results We compared characteristics, treatment strategies, and
outcomes among patients with a CHA2DS2VASc=0, CHA2DS2VASc=1, females with a CHA2DS2VASc=2,
and CHA2DS2VASc ≥2 in ORBIT-AF (Outcomes Registry for Better Informed Treatment of
Atrial Fibrillation) I & II. Compared with CHA2DS2VASc ≥2 patients (84.2%), those
with a CHA2DS2VASc=0 (60.3%), 1 (69.9%), and females with a CHA2DS2VASc score=2 (72.4%)
were significantly less often treated with oral anticoagulation ( P<0.0001). Stroke
rates were low overall and ranged from 0 per 100 patient-years in those with CHA2DS2VASc=0,
0.8 (95% confidence interval [CI] [0.5-1.2]) in those with CHA2DS2VASc=1, 0.8 (95%
CI [0.4-1.6]) in females with a CHA2DS2VASc score=2, and 1.7 (95% CI [1.6-1.9]) in
CHA2DS2VASc ≥2. All-cause mortality (per 100 patient-years) was highest in females
with a CHA2DS2VASc score=2 (1.4) (95% CI [0.8-2.3]), compared with patients with a
CHA2DS2VASc=0 (0.2) (95% CI [0.1-1.0]), and CHA2DS2VASc=1 (1.0) (95% CI [0.7-1.4]),
but lower than patients with a CHA2DS2VASc ≥2 (5.7) (95% CI [5.4-6.0]). Conclusion
The majority of CHA2DS2VASc=0-1 patients are treated with oral anticoagulation. In
addition, the absolute risks of death and stroke/transient ischemic attack were low
among both male and females CHA2DS2VASc=0-1 as well as among females with a CHA2DS2VASc
score=2. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier:
NCT01701817.
Type
Journal articleSubject
Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Patients and
InvestigatorsPermalink
https://hdl.handle.net/10161/17832Published Version (Please cite this version)
10.1161/jaha.118.008764Publication Info
Jackson, Larry R; Kim, Sunghee; Fonarow, Gregg C; Freeman, James V; Gersh, Bernard
J; Go, Alan S; ... Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
Patients and Investigators (2018). Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA2DS2-VASc
Scores: Findings From the ORBIT-AF I and II Registries. Journal of the American Heart Association, 7(16). pp. e008764. 10.1161/jaha.118.008764. Retrieved from https://hdl.handle.net/10161/17832.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Larry Ronald Jackson II
Assistant Professor of Medicine
Eric David Peterson
Fred Cobb, M.D. Distinguished 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
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
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
Laine Elliott Thomas
Associate Professor of Biostatistics and Bioinformatics
Measurement error, longitudinal data, joint modeling
Alphabetical list of authors with Scholars@Duke profiles.

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