Abstract 170: Pharmacological Stroke Prophylaxis and Correlates among Patients with Atrial Fibrillation: The US National Health and Wellness Survey

Abstract

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 CHADS 2 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 CHADS 2 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 CHADS 2 ≥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). CHADS 2 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, CHADS 2 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.