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Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA2DS2-VASc Scores: Findings From the ORBIT-AF I and II Registries.

dc.contributor.author Jackson, Larry R
dc.contributor.author Kim, Sunghee
dc.contributor.author Fonarow, Gregg C
dc.contributor.author Freeman, James V
dc.contributor.author Gersh, Bernard J
dc.contributor.author Go, Alan S
dc.contributor.author Hylek, Elaine M
dc.contributor.author Kowey, Peter R
dc.contributor.author Mahaffey, Kenneth W
dc.contributor.author Singer, Daniel
dc.contributor.author Thomas, Laine
dc.contributor.author Blanco, Rosalia
dc.contributor.author Peterson, Eric D
dc.contributor.author Piccini, Jonathan P
dc.contributor.author Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Patients and Investigators
dc.date.accessioned 2019-01-01T15:54:50Z
dc.date.available 2019-01-01T15:54:50Z
dc.date.issued 2018-08
dc.identifier.issn 2047-9980
dc.identifier.issn 2047-9980
dc.identifier.uri https://hdl.handle.net/10161/17832
dc.description.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.
dc.language eng
dc.publisher Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof Journal of the American Heart Association
dc.relation.isversionof 10.1161/jaha.118.008764
dc.subject Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Patients and Investigators
dc.title Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA2DS2-VASc Scores: Findings From the ORBIT-AF I and II Registries.
dc.type Journal article
duke.contributor.id Jackson, Larry R|0437408
duke.contributor.id Thomas, Laine|0402620
duke.contributor.id Peterson, Eric D|0130909
duke.contributor.id Piccini, Jonathan P|0373399
dc.date.updated 2019-01-01T15:54:49Z
pubs.begin-page e008764
pubs.issue 16
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Basic Science Departments
pubs.organisational-group Population Health Sciences
pubs.publication-status Published
pubs.volume 7
duke.contributor.orcid Peterson, Eric D|0000-0002-5415-4721


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