Abstract
Purpose
The purpose of this study is to report on the effect of using CHA2DS2VASc (congestive heart failure, hypertension, age ≥75 years [doubled], type 1 or type
2 diabetes mellitus, stroke or transient ischemic attack or thromboembolism [doubled],
vascular disease [prior myocardial infarction, peripheral artery disease, or aortic
plaque], age 65–75 years, sex category [female]) rather than CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior
stroke) to determine candidacy for anticoagulant prophylaxis in insured patients with
atrial fibrillation (AF).
Methods
Six administrative claims databases that included medical and pharmacy claims for
patients aged ≥18 years with a new or existing diagnosis of AF and patient outcomes
assessed for 1 year after diagnosis were analyzed. Retrospective health plan data
analyses were performed using a software tool (Anticoagulant Quality Improvement Analyzer).
Study measures included stroke risk (identified by CHADS2 and CHA2DS2VASc scores), bleeding risk (identified by the Anticoagulation and Risk Factors in
Atrial Fibrillation score), and anticoagulant use.
Findings
A total of 115,906 patients with AF (range of mean ages among the 6 databases, 56–79
years) met the inclusion criteria. All ranges reported represent the minimum and maximum
values among the 6 databases. Using the CHA2DS2VASc compared with the CHADS2 index to assess stroke risk resulted in a 23% to 32% increase in patients considered
potential candidates for anticoagulant prophylaxis. This translated to a 38% to 114%
increase in the number of ostensibly undertreated patients. Among patients with high
stroke and low bleeding risk, 18% to 28% more patients were considered potential candidates
for anticoagulation treatment using CHA2DS2VASc compared with CHADS2, or a 57% to 151% increase in the number of undertreated patients.
Implications
Use of the CHA2DS2VASc score to determine the risk of stroke increased the number of AF patients for
whom oral anticoagulation would be recommended. Additional research is needed to determine
whether this paradigm shift to greater use of oral anticoagulants improves patient
outcomes.
Key words
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Article info
Publication history
Published online: September 23, 2016
Accepted:
August 21,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
