Arrhythmias & electrophysiology
Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation: a report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry
Authors' conclusion
Only 44.7% of all eligible patients were prescribed OAC in accordance with guideline recommendations.
Study context
- Population
- Elderly Chinese patients with atrial fibrillation (AF) and a guideline-directed indication for oral anticoagulation (OAC) (CHA2DS2-VASc ≥1 if male or ≥2 if female), October 2014 to December 2018eligible cohort
- Participants
- 5,742 patients
- Exposure
- OAC undertreatment vs guideline-directed OAC therapy
- Guideline-directed OACn = 2,567reference
- Outcome
- Adherence to guideline-directed OAC; endpoints of interest all-cause death, TE events and major bleeding
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
OAC treatment rate (guideline-directed indication) and association of OAC undertreatment with outcomes
OAC undertreatment vs Guideline-directed OACOdds ratio (95% CI)P value
All-cause death; multivariate analysis
3.79(2.61–5.53)
P < 0.001TE events; multivariate analysis
2.28(1.39–3.72)
P = 0.001- Treated with OAC (eligible cohort n = 5742)
- 2567 (44.7%)
Observational data: associations, not effects.
Further findings
Independent predictors of OAC undertreatment
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| Age | 1.04 (1.03–1.05) | P < 0.001 | |
| First diagnosed AF | 1.71 (1.44–2.03) | P < 0.001 | |
| CKD | 1.67 (1.36–2.06) | P < 0.001 | |
| Liver disease | 1.69 (1.19–2.41) | P = 0.003 | |
| Dementia | 1.67 (1.06–2.64) | P = 0.026 | |
| Prior extracranial bleeding | 1.89 (1.35–2.64) | P < 0.001 | |
| Antiplatelet drug use | 6.97 (5.89–8.23) | P < 0.001 | |
| 0.10.31310Odds ratio (log scale) |
All-cause death and thromboembolic (TE) events
- Multivariate analysis
Safety
- Similar risk of major bleeding with OAC undertreatment vs guideline-directed OAC
- Multivariate analysis
Original publication
Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation: a report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry. Eur Heart J Qual Care Clin Outcomes. Published 9 August 2021. doi:10.
Summarised from the published abstract; every number is checked against it