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

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Fonarow, Gregg C

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Freeman, James V

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Gersh, Bernard J

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Go, Alan S

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Hylek, Elaine M

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Kowey, Peter R

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Mahaffey, Kenneth W

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Singer, Daniel

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Thomas, Laine

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Blanco, Rosalia

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Peterson, Eric D

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Piccini, Jonathan P

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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

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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

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2047-9980

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https://hdl.handle.net/10161/17832

dc.language

eng

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Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Journal of the American Heart Association

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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

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Duke

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Medicine, Cardiology

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Medicine

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Clinical Science Departments

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Duke Clinical Research Institute

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Institutes and Centers

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Biostatistics & Bioinformatics

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Basic Science Departments

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Population Health Sciences

pubs.publication-status

Published

pubs.volume

7

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