Abstract 22: Impact of CHA2DS2-VASc Risk Factors on Anticoagulant Prescription in Patients with Atrial Fibrillation: Insights From the NCDR® PINNACLE Registry

Abstract

Background: The CHA2DS2-VASc score is a tool to assess thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Whether individual components of the CHA2DS2-VASc score are considered equivalent in decisions to use oral anticoagulant (OAC) in current clinical practice is unknown. Method: Using data collected in the outpatient National Cardiovascular Data Registry (NCDR) PINNACLE registry from 2010-2014, OAC use (warfarin or novel anti-coagulants versus none) was compared in patients with non-valvular AF and an indication for OAC (CHA2DS2-VASc ≥ 2). We assessed the association between individual CHA2DS2VASc components (female gender, congestive heart failure (CHF), hypertension (HTN), age 64-75, age ≥ 75, diabetes mellitus (DM), vascular disease, and stroke/transient ischemic attack (TIA)) and OAC use, adjusting for demographics, clinical factors, modified HASBLED (mHASBLED) scores, and accounting for clustering by hospital and provider with multivariable logistic regression models. Result: Of 706,308 patients with non-valvular AF and an indication for OAC use (CHA2DS2-VASc ≥2), 65% were white and mean age was 74.4±10.7. The mean CHA2DS2-VASc score was 3.93±1.42; 48% were female, 26% had CHF, 80% had HTN, 84% were age ≥ 65, 24% had DM, and 4% had stroke/TIA. Among this cohort with an indication for OAC use, in unadjusted models, female gender (OR 0.83, 95% CI 0.82-0.84) and vascular disease (OR 0.75, 95% CI 0.71-0.79) were associated with significantly less OAC use. In adjusted models, gender and vascular disease remained significantly associated lower OAC use whereas age and HTN were associated with higher OAC use. (FIGURE) Conclusions: Among this cohort of AF patients with an indication for OAC use, older age and HTN were strongly associated with greater OAC use whereas female gender and vascular disease were associated with less OAC use. Further investigation is needed to understand reasons for these differences in how risk factors influence decisions to provide OAC, such as patient or provider preference or gender bias.