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.date.updated | 2019-01-01T15:54:49Z | |
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.identifier.issn | 2047-9980 | |
dc.identifier.issn | 2047-9980 | |
dc.identifier.uri | ||
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.orcid | Jackson, Larry R|0000-0002-0195-1081 | |
duke.contributor.orcid | Peterson, Eric D|0000-0002-5415-4721 | |
duke.contributor.orcid | Piccini, Jonathan P|0000-0003-0772-2404 | |
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 |
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