Abstract 170: Pharmacological Stroke Prophylaxis and Correlates among Patients with Atrial Fibrillation: The US National Health and Wellness Survey
Purpose: To describe pharmacological stroke prophylaxis and identify patient characteristics associated with vitamin K antagonist (VKA) and/or aspirin (ASA) use among adult patients with atrial fibrillation (AF).
Methods: Data were analyzed from the 2009 U.S. National Health and Wellness Survey, a self-administered, internet-based epidemiological study of a nationwide sample of 75,000 adults (aged 18+) stratified by gender, age, and race/ethnicity. Included were a total of 1,290 participants (1.72%) who checked AF diagnosis among their condition(s) that have “been diagnosed by a physician” (mean age=64.9 years, 65% male). AF patients were asked about their current treatments for AF or stroke prevention. Stroke prophylaxis patterns were identified as VKA only (VKA), ASA only (ASA), both VKA and ASA (VKA+ASA), and no VKA or ASA (non-VKA/ASA). Logistic regressions were used to examine factors associated with prophylaxis patterns, including demographics, health insurance, smoking, exercise, alcohol use, body mass index (BMI), modified Charlson comorbidity index , and CHADS2 score (0, 1, or 2+).
Results: Among AF participants, 343 (26.6%) were treated with VKA, 445 (34.5%) with ASA, 199 (15.4%) with VKA+ASA, and 303 (23.5%) with neither. Compared with non-VKA/ASA users, VKA or ASA users were more likely to be male, older, obese, and have a higher CHADS2 score. Compared with VKA users, ASA users were younger and had more comorbidities. Multivariate logistic regression models showed that, compared with non-VKA/ASA use, obesity (OR=2.03, p=0.02), being married (OR=3.24, p=0.02), and male gender (OR=2.00, p=0.002) were associated with VKA+ASA use, and CHADS2≥1 was associated with VKA or ASA use (OR≥1.69, p≤0.017). Comorbidities were associated with ASA versus VKA use (OR=1.68-3.79, p≤0.01). CHADS2 score was not associated with VKA versus ASA use (p>0.4).
Conclusions: More than half of AF patients were not treated at all (23%) or treated with ASA only (34.5%) for stroke prevention. While older age, male gender, obesity, and stroke risk were associated with VKA or ASA treatment, CHADS2 score was not related to VKA versus ASA treatment. Further study is needed to examine the clinical and economic consequences of VKA and ASA treatment among AF patients in a real-world setting.
- © 2012 by American Heart Association, Inc.