Abstract 16530

High Use of Oral Anticoagulation in Eligible Patients Discharged With Heart Failure and Atrial Fibrillation Irrespective of Ejection Fraction Insights From the AHA Get With The Guidelines- Atrial Fibrillation Program

Luo, Nancy
Xu, Haolin
Jneid, Hani
Fonarow, Gregg C
Lopes, Renato D
Granger, Christopher B
Curtis, Anne B
Russo, Andrea M
Lewis, William R
Piccini, Jonathan P
Mentz, Robert J
Al-Khatib, Sana M

¹Div of Cardiology, Duke Univ Med Cntr, Durham, NC
²Duke Clinical Rsch Insittute, Duke Clinical Rsch Insittute, Durham, NC
³Div of Cardiology, Baylor College of Medicine, Houston, TX
⁴Ahmanson-UCLA Cardiomyopathy Cntr, Univ of California, Los Angeles, Los Angeles, CA
⁵Duke Clinical Rsch Insittute, Duke Univ Med Cntr, Durham, NC
⁶Dept of Medicine-Div of Cardiology, Univ at Buffalo, Buffalo, NY
⁷Div of Cardiology, Cooper Med Sch of Rowan Univ, Camden, NJ
⁸Heart and Vascular Cntr, MetroHealth Med Cntr, Cleveland, OH

Author Disclosures: N. Luo: None. H. Xu: None. H. Jneid: None. G.C. Fonarow: Consultant/Advisory Board; Significant; Janssen Scientific Affairs, LLC, Bayer. R.D. Lopes: Consultant/Advisory Board; Modest; Bayer, Boehringer Ingleheim, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Merck, Portola. Research Grant; Significant; Bristol-Myers Squibb, Glaxo Smith Kline, Medtronic, Pfizer. Consultant/Advisory Board; Significant; Glaxo Smith Kline, Pfizer. C.B. Granger: Research Grant; Significant; Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, GlaxoSmithKline, Janssen, Medtronic Foundation, Novartis, Pfizer, The Medicines Company. Consultant/Advisory Board; Modest; AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Inc, GlaxoSmithKline, Hoffman LaRoche, Janssen, Medtronic, Novartis, Pfizer, The Medicines Company, Verseon. A.B. Curtis: Honoraria; Modest; Medtronic, St. Jude Medical. Consultant/Advisory Board; Modest; St. Jude Medical, Daiichi Sankyo, Medtronic. A.M. Russo: Research Grant; Modest; Boston Scientific, Medtronic. Honoraria; Modest; Biotronik, Boston Scientific, Medtronic, St. Jude Medical. W.R. Lewis: None. J.P. Piccini: Research Grant; Modest; Agency for Healthcare Research and Quality, ARCA biopharma, Boston Scientific, Gilead Sciences, Janssen Pharmaceuticals, Johnson & Johnson, ResMed, Spectranetics, and St Jude Medical. Consultant/Advisory Board; Modest; BMS/Pfizer, GlaxoSmithKline, Janssen Pharmaceuticals, Johnson & Johnson, Medtronic, and Spectranetics. R.J. Mentz: Research Grant; Significant; National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Novartis, Otsuka, and ResMed. Honoraria; Modest; HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. S.M. Al-Khatib: None.

Circulation 136(Suppl_1):p A16530, November 14, 2017.

Background: Prior studies have shown underuse of oral anticoagulation (OAC) for stroke prophylaxis in patients with atrial fibrillation (AF) and heart failure (HF). The use of OAC in the era of direct anticoagulants (DOAC) is not well characterized.

Objective: Using data from the AHA Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) program—a registry of hospitalized patients with AF, we sought to evaluate baseline characteristics and OAC use at discharge among those with concomitant HF.

Methods: Patients hospitalized for AF from 01/2013 to 03/2017 with a diagnosis of HF and documented EF assessment were included in this analysis. We compared patient characteristics and discharge OAC among patients with reduced (HFrEF, EF≤40%), borderline (HFbEF, EF=41-49%), and preserved (HFpEF, EF≥50%) EF using mixed logistic regression models with hospital random intercepts.

Results: Among 10,883 patients with AF and HF, 1,790 (16.5%) had a reported contraindication to anticoagulation and were excluded from further analysis. Among 9,093 patients eligible for OAC, 3,499 had HFrEF (38.5%), 1,062 had HFbEF (11.7%), and 4,532 had HFpEF (49.8%). Compared with those with HFbEF and HFpEF, patients with HFrEF were younger and more likely male (Table). The median CHA₂DS₂-VASc score was ≥ 2 among all patients and higher among those with HFpEF than HFrEF (Table). On admission, 19.9% of patients had a first detected AF episode, and 62% of patients reported prior OAC use. The proportion of patients discharged on an OAC was 94.9%, with 43.6% discharged on warfarin and 50.7% discharged on a DOAC. A higher proportion of patients with HFrEF and HFbEF were discharged on DOAC than HFpEF, but the difference was small (48.5% vs 52.8-53.1%; Table).

Conclusions: In the context of the AHA GWTG-AFIB, a quality improvement program, the rate of use of OAC at discharge in AF patients with HF was very high (~95%). Future studies should determine the rate of adherence to and persistence of OAC post discharge.