Rates Of Oral Anticoagulation Use Research Articles

Trends in newly diagnosed atrial fibrillation and oral anticoagulant use after cardiac surgery: a population-based analysis from Ontario, Canada

Abstract Background Post-operative atrial fibrillation after cardiac surgery is associated with an increased risk of death and ischemic cardiovascular outcomes. In the non-surgical setting, oral anticoagulation (OAC) is beneficial among patients with AF in reducing their risk of thromboembolism. The use of OAC for patients with post-operative AF after cardiac surgery is not well-defined in contemporary clinical practice - at a time when direct oral anticoagulants (DOAC) are commonly prescribed in the non-surgical setting. Purpose To examine trends in OAC use among patients with post-operative atrial fibrillation after cardiac surgery at a time when DOAC is commonly prescribed in clinical practice. Methods The study cohort consisted of consecutive patients (>65 years) who experienced post-operative AF within 90 days after coronary artery bypass grafting (CABG), isolated left-sided non-mechanical heart valve surgery (iValve), and combined CABG + valve surgery between 2008 and 2021, identified by a mandatory provincial registry of all patients undergoing cardiac surgery in Ontario, Canada. Key exclusion criteria included: patients with pre-existing AF, end-stage renal disease requiring dialysis, mechanical heart valves, left atrial appendage ligation, and those who required anticoagulation for non-AF indications. Prescription of OAC (warfarin or DOAC) within 90 days after discharge from surgery was collected via linkage with the Ontario Drug Benefits Plan. Results The overall cohort consisted of 45,571 patients, in whom 14,572 (32.0%) developed POAF after cardiac surgery. Rates of POAF were highest among patients who underwent combined CABG + valve surgery (44.3% in 2008 to 34.2% in 2021), followed by iValve (42.6% in 2008 to 37.3% in 2021), then followed by isolated CABG (27.6% in 2008 to 24.2% in 2021). Over the study period, there was a decrease in the rates of POAF among patients who underwent all three types of cardiac surgery (P[trend] <0.01). In 2021, rates of oral anticoagulation were highest among patients who underwent combined CABG + valve surgery (61.1%), followed by iValve (59.2%) and isolated CABG (42.0%). Among patients who underwent isolated CABG, there was a 9% increase in the rates of OAC use during the study period (P[trend] <0.001). On the other hand, rates of OAC use remained largely unchanged (Figure A) among patients who underwent iValve and combined CABG + valve surgery (P[trend] 0.24 and 0.26, respectively). Since 2018, DOAC accounted for 60-70% of all OAC prescriptions (Figure B). Conclusions Despite advances in surgical techniques and post-operative care, the rates of post-operative atrial fibrillation after cardiac surgery remain substantial. Prescription rates for OAC remain modest over the past decade, but DOAC is increasingly more commonly prescribed in this patient population. Randomized trials are needed to assess the risks and benefits of OAC, specifically DOAC, in this high-risk patient population.Figure AFigure B

Retrospective Cross-sectional Analysis of Older Adults Living with Frailty and Anticoagulant Use for Atrial Fibrillation.

Oral anticoagulation (OAC) is recommended for most individuals with atrial fibrillation (AF), including those who are frail. Based on previous literature, those who are frail may be less likely to be prescribed OAC, and up to one-third may receive an inappropriate dose if prescribed a direct oral anticoagulant (DOAC). The objectives of this study were to determine the proportion of frail ambulatory older adults with AF who are prescribed OAC, compare the rates of OAC use across the frailty spectrum, assess the appropriateness of DOAC dosing, and identify if frailty and geriatric syndromes impact OAC prescribing patterns. Retrospective cross-sectional review of individuals with AF referred to an ambulatory clinic for older adults living with frailty and/or geriatric syndromes. Rockwood clinical frailty score of ≥4 was used to define frailty and DOAC appropriateness was assessed based on the Canadian Cardiovascular Society AF guidelines. Two hundred and ten participants were included. The mean age was 84 years, 49% were female and the median frailty score was 5. Of the 185 participants who were frail, 82% were prescribed an OAC (83% with frailty score of 4, 85% with a frailty score of 5, and 78% with a frailty score of 6). Of those prescribed a DOAC, 70% received a guideline-approved dose. Over 80% of ambulatory older adults with frailty and AF were prescribed an OAC. However, of those prescribed a DOAC, 30% received an unapproved dose, suggesting more emphasis should be placed on initial and ongoing dosage selection.

Impact of NOAC and VKA on outcome of patients with newly diagnosed atrial fibrillation and diabetes: a report from the GARFIELD-AF registry

Abstract Introduction Diabetes mellitus (DM) is one of the most common comorbidities observed in patients with atrial fibrillation (AF). It is associated with increased risks of stroke/SE and death. Purpose To assess the impact of NOAC and VKA on outcomes of newly diagnosed AF in patients with DM and 2-year follow-up. Methods The study population comprised 52,010 patients with newly diagnosed AF, 11,542 DM and 40,468 non-DM, who were enrolled in GARFIELD-AF, the largest multinational prospective AF registry. Adjusted hazard ratios (HRs) were obtained through Cox proportional-hazard models to quantify the effects of diabetes on death, stroke/SE and major bleeding. Comparative effectiveness analyses were restricted to 18,373 patients eligible for oral anticoagulation (OAC) enrolled between 2013- 2016 after NOACs became available in most countries. Safety and effectiveness of NOAC and VKA in DM and non-DM patients were assessed with propensity scores using an overlap weighting scheme. Weights were applied to Cox proportional-hazards models to estimate the effects of NOAC vs VKA use for each endpoint. Results Compared to non-DM patients, DM patients (44.5% with oral antidiabetic drug, 13.4% with insulin) had higher BMI (28.7 vs 26.4), more frequent history of heart failure (24.8% vs 21.9%), acute coronary syndromes (15.9% vs 9.2%), vascular disease (32.6% vs 22.6%), stroke/TIA/SE (12.8% vs 10.9%), hypertension (85.7% vs 73.7%), hypercholesterolemia (55.3% vs 37.7%), moderate to severe CKD (14.4% vs 9.6%). They had higher rates of OAC use (70.5% vs 65.8%), were more often treated with VKA (44.0% vs 38.0%), or AP in combination with OAC or as monotherapy (40.6% vs 33.8%), were at higher risk of stroke/SE according to CHA2DS2-VASc score [4.0 (3.0; 5.0) vs (3.0 (2.0; 4.0)], had at 2-year follow-up significantly higher rates of all-cause death, stroke/SE, and major bleeding (Figure 1). Overall, OAC vs no OAC led in both non-DM and DM populations to similar risk reduction for death [HR 0.75 (0.69–0.83) vs 0.74 (0.64–0.86)], stroke/SE [0.69 (0.58–0.83) vs 0.70 (0.53–0.93)], and similar increase in major bleeding risk [HR 1.40 (1.14–1.71) vs 1.37 (0.99–1.89)]. NOAC use trended toward lower all-cause death (significant for non-DM but not for DM) and major bleeding rates than VKA in both non-DM and DM patients. A non-significant increase in stroke/SE rates was observed in DM patients (Figure 2). Conclusion At baseline, DM patients had higher rates of OAC prescription. They had higher rates of all cause, cardiovascular and non-cardiovascular death, stroke/SE, and major bleeding than non-DM patients. Lower rates of all-cause death and of major bleeding were observed with NOACs compared with VKAs in both DM and non-DM patients and of stroke/SE in non-DM patients. These results tend to show that in DM AF patients, NOACs should be favoured over VKA, though higher rates of CKD in DM patients may limit the uptake of such drugs. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry was funded by an unrestricted research grant from Bayer AG. This work is supported by KANTOR CHARITABLE FOUNDATION for the Kantor-Kakkar Global Centre for Thrombosis Science.

Abstract 14156: Automated Electronic Medical Record Mapping to Identify Acute Precipitants of Atrial Fibrillation and Oral Anticoagulation Use

Introduction: Atrial fibrillation (AF) that is associated with acute precipitants frequently recurs and is associated with long-term morbidity and mortality. Leveraging a large electronic medical record (EMR) database, we previously reported the performance of an automated EMR-based algorithm to identify the acute precipitants of newly detected-AF, but its validation in other databases has not been performed. Hypothesis: Modified EMR-based algorithm would accurately identify acute precipitants of AF and oral anticoagulation (OAC) use after AF diagnosis Methods: Among all records (inpatient/outpatient/ER) in a single-institution EMR (10/1/17 - 12/31/19), we first identified 4493 records documenting newly-diagnosed AF (ICD 10: I48). We then applied the modified EMR-based algorithm to identify 13 acute AF precipitants (within 30 days of AF diagnosis, Figure 1) and determine OAC use after an AF diagnosis. We manually adjudicated a random subset of identified records (892 of 4493) to derive performance metrics of the EMR algorithm. Results: Of 4493 records with newly-diagnosed AF, the algorithm identified ≥1 acute precipitant in 831 records and ≥2 precipitants in 206 records. The most common precipitants were respiratory failure (38%) and pneumonia (35%). Among patients with CHADS2Vasc ≥2, 44% with an acute precipitant were prescribed an OAC vs. 63% free from a precipitant after initial AF diagnosis. EMR algorithm accurately identified the precipitants and OAC use after AF diagnosis (PPV 89% for both, Figure 1). Conclusions: In this validation study, our novel EMR-based automated algorithm was highly accurate at identifying acute precipitants of AF and OAC use after AF diagnosis. We also observed differential rates of OAC use between those with and without an acute precipitant. Application of the algorithm to multi-institutional datasets could help map the gaps in care (e.g., OAC use) AF patients with acute precipitants often experience.

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa.

Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16–22% in heart failure, 10–28% in rheumatic heart disease, 3–7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9–79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries.Highlights:- Atrial fibrillation/flutter prevalence is 16–22% in heart failure, 10–28% in rheumatic heart disease, 3–7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9–79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

BackgroundIt has been reported that oral anticoagulation (OAC) is underused among Chinese patients with non-valvular atrial fibrillation (NVAF). Non-vitamin K antagonist oral anticoagulants (NOAC) have been recommended by recent guidelines and have been covered since 2017 by the Chinese medical insurance; thus, the overall situation of anticoagulant therapy may change. The aim of this study was to explore the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province.MethodsThis was a multi-center, cross-sectional study that was conducted in seven hospitals from January to September in 2017. The demographic characteristics and medical history of the patients were collected by questionnaire and from the medical records. Multivariate logistic regression was used to identify factors associated with anticoagulant therapy.ResultsA total of 593 patients were included in the analysis. A total of 35.6% of the participants received OAC (11.1% NOAC and 24.5% warfarin). Of those patients with a high risk of stroke, 11.1% were on NOAC, 24.8% on warfarin, 30.6% on aspirin, and 33.6% were not on medication. Self-paying, duration of AF ≥5 years were negatively associated with anticoagulant therapy in all patients (OR 1.724, 95% CI 1.086~2.794; OR 1.471, 95% CI 1.006~2.149, respectively), whereas, permanent AF was positively associated with anticoagulant therapy (OR 0.424, 95% CI 0.215~0.839). Among patients with high risk of stroke, self-paying and increasing age were negatively associated with anticoagulant therapy (OR 2.305, 95% CI 1.186~4.478; OR 1.087, 95% CI 1.041~1.135, respectively).ConclusionsAnticoagulant therapy is positively associated with permanent AF and negatively associated with self-paying, duration of AF > 5 years. Furthermore, the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province does not appear optimistic. Therefore, further studies should focus on how to improve the rate of OAC use among NVAF patients. In addition, policy makers should pay attention to the economic situation of the patients with NVAF using NOAC.Trial registration2,017,029. Registered 20 March 2017 (retrospectively registered).

Abstract 232: Effect of Oral Anticoagulation Use on Thromboembolic Risk and Bleeding in Women Compared with Men with Atrial Fibrillation: Findings from the PINNACLE Data Registry

Background: Among those with atrial fibrillation (AF), women have a higher risk of thromboembolic events and lower use of oral anticoagulation (OAC) when compared to men. Whether the effect of gender on thromboembolic risk in patients with AF is mediated by lower use of OAC among women is unknown. We examined whether gender differences in OAC use mediated the relationship between gender and thromboembolic risk in patients with AF. Methods: Adults 65 years and older with AF in the PINNACLE Registry from October 2008 to December 2014 were identified. Adults with valvular AF and contraindications to OAC use were excluded. Thromboembolic events (stroke, systemic embolism) and major bleeding events were determined using linked Medicare claims data. Site-stratified proportional hazard models adjusting for patient and practice-level characteristics compared thromboembolic and bleeding events by gender, as well as the mediating effect of OAC use as a time-dependent covariate on these outcomes. Results: Among 667,287 patients, the mean ±standard deviation age was 77±8 years and 46% were women. Compared to men, women had higher CHA2DS2-Vasc scores (mean 4.8 vs. 3.8, p&lt;0.001), had similar prevalence of bleeding risk factors, but were prescribed OAC less frequently (51.5% vs. 53.8%, p&lt;0.001). Over a median 2 years of follow up (range 0-6 years), there were 25,947 thromboembolic events and 40,967 major bleeding events. Women had a higher risk of thromboembolic events compared to men (5-year cumulative incidence 8.3% vs. 6.0%, adjusted hazard ratio [HR] 1.24, 95% CI 1.16-1.33) and a slightly lower risk of major bleeding (5-year cumulative incidence 10.4% vs. 11.2%, adjusted HR 0.90, 95% CI 0.83-0.98). Among adult patients with AF, OAC use was associated with lower thromboembolic risk (HR 0.90, 95% CI 0.86-0.94) and greater bleeding risk (HR 1.51, 95% CI 1.42-1.60). Among women, OAC use did not mediate the relationship between gender and either thromboembolic or major bleeding events (HR 1.24 and 0.90 respectively, identical to the unmediated effects). Conclusions: In a national US sample of older adults with AF, women had lower rates of OAC use, higher risk of thromboembolic events and lower risk of major bleeding. However, the difference in OAC use did not explain the gender differences in these outcomes. These findings underscore that women with AF are independently at higher risk for thromboembolic events and lower OAC use among women does not significantly explain this higher risk.

Electronic Decision support for Improvement of Contemporary Therapy for Stroke Prevention

BackgroundDespite ample clinical trial data demonstrating that oral anticoagulation (OAC) treatment is highly effective in reducing stroke for patients with atrial fibrillation (AF), OAC treatment remains underutilized in current clinical practice. Targeting hospitalist and emergency department providers with electronic decision support represents a potential quality improvement opportunity in the use of OAC medication in AF patients. MethodsWe conducted a 3-center study in which 2 sites utilized an electronic alert (EA) embedded in the electronic health record and 1 site provided usual care. The EA calculated the CHA2DS2-VASc score for clinicians. Patients were tracked following discharge from either the emergency department or hospital. We hypothesized that the EA would increase the rate of OAC use by 15% compared to usual care, with a study sample size of 360 patients. Study exclusions included severe heart valve disease, advanced renal disease, and severe dementia. The primary endpoint was OAC use at the time of hospital discharge or 30 days after hospital discharge (whichever was the last observation recorded). ResultsAmong 309 patients included for analysis (mean age 70.2 years), the median CHA2DS2-VASc score was 3.5. The frequency of OAC use at follow-up at the usual care hospital was 55.9% (95% confidence interval 47.4-67.9). At the 2 EA sites, the rate of OAC use at the last observation point was 43.9% (P = .06). Aspirin use at follow-up was similar at the usual care site and the EA sites (53.8% versus 46.3%). The rate of OAC use in patients greater than 75 years was 60.0% in the usual care site and 48.4% (P = .09) at the EA sites. ConclusionsThe EA in our study was not sufficient to ameliorate therapeutic inertia in the use of OAC for stroke prevention in AF.

PO383 The Rates of Oral Anticoagulation Use in Patients With Atrial Fibrillation – Preliminary Data from Pinnacle-Brazil Registry

PO383 The Rates of Oral Anticoagulation Use in Patients With Atrial Fibrillation – Preliminary Data from Pinnacle-Brazil Registry

The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED)

Lack of oral anticoagulation prescription in the emergency department (ED) has been identified as a care gap in atrial fibrillation patients. This study seeks to determine whether the use of a tool kit for emergency physicians with a follow-up community-based atrial fibrillation clinic resulted in greater oral anticoagulation prescription at ED discharge than usual care. This was a before-after study in 5 Canadian EDs in 3 cities. Patients who presented to the ED with atrial fibrillation were eligible for inclusion. The before phase (1) was retrospective; 2 after phases (2 and 3) were prospective: phase 2 used an oral anticoagulation prescription tool for emergency physicians and patient education materials, whereas phase 3 used the same prescription tool, patient materials, atrial fibrillation educational session, and follow-up in an atrial fibrillation clinic. Each phase was 1 year long. The primary outcome was the rate of new oral anticoagulation prescription at ED discharge for patients who were oral anticoagulation eligible and not receiving oral anticoagulation at presentation. A total of 631 patients were included. Mean age was 69 years (SD 14 years), 47.4% were women, and 69.6% of patients had a CHADS2 score greater than or equal to 1. The rate of new oral anticoagulation prescription in phase 1 was 15.8% compared with 54.1% and 47.2%, in phases 2 and 3, respectively. After multivariable adjustment, the odds ratio for new oral anticoagulation prescription was 8.03 (95% confidence interval 3.52 to 18.29) for phase 3 versus 1. The 6-month rate of oral anticoagulation use was numerically but not significantly higher in phase 3 compared with phase 2 (71.6% versus 79.4%; adjusted odds ratio 2.30; 95% confidence interval 0.89 to 5.96). The rate of major bleeding at 6 months was 0%, 0.8%, and 1% in phases 1, 2, and 3, respectively. An oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow-up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6-month follow-up.

Situation of long-term use of oral anticoagulation among atrial fibrillation patients with stroke in different level hospital

To investigate the current situation, time trends and factors associated with long-term use of oral anticoagulation (OAC) among atrial fibrillation (AF) patients with ischemic stroke. We used the dataset from the CAFR (Chinese Atrial Fibrillation Registry), a prospective, multicenter, hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. In brief, 380 consecutive AF patients with following ischemic stroke were enrolled from 2003 to 2014.Patients with valvular AF, radiofrequency catheter ablation history or contraindications of OAC were excluded. We divided the patients into two groups according to hospital level, and investigated the rate of OAC use and its change over time in patients who had indication, the factors including patient characteristics and hospital level associated with OAC use were also analyzed. Overall oral anticoagulation use rate was 27.71%, which dropped to 22.11% and 15.26% at 6 months and 12 months, respectively.A total of 298 participates were enrolled from tertiary hospitals (78.42%), and 82 were enrolled from nontertiary hospitals. The status of OAC use in tertiary hospitals was better than nontertiary hospitals (32.66% vs 7.32%, P<0.001). Multivariable analysis showed better oral anticoagulation use was independently associated with higher-level hospitals (odds ratio 1.785, 95% confidence interval 1.026-3.106, P=0.040), and history of heart failure (odds ratio 2.247, 95% confidence interval 1.235-4.090, P=0.008). These data indicates oral anticoagulation use has improved in atrial fibrillation patients with stroke in Beijing. The use of anticoagulation among the patients from tertiary hospitals is significantly better than those from nontertiary hospitals, and the history of heart failure may have effect on the use of oral anticoagulation.

A clustered randomized trial to IMProve treatment with AntiCoagulanTs in patients with Atrial Fibrillation (IMPACT-AF): design and rationale

Atrial fibrillation (AF) is common, increasing as the population ages, and a major cause of embolic stroke. While oral anticoagulation (OAC) is highly effective at preventing stroke in patients with AF, it continues to be underused in eligible patients worldwide. The objective of this prospective, cluster randomized controlled trial (IMPACT-AF; ClinicalTrials.gov #NCT02082548) is to determine whether a comprehensive customized intervention will increase the rate and persistence of use of OAC in patients with AF. IMPACT-AF will be conducted in approximately 50 centers in 5 low- to middle-income countries. Before randomization, sites within countries will be paired to match in size, practice type and baseline rate of OAC use. Site pairs will be randomized to intervention versus control. In total, 40 to 70 patients with AF and at least 2 CHA2DS2-VASc risk factors will be enrolled at each site using a consecutive enrollment strategy, with the goal of capturing actual practice patterns. We aim for patients with a new diagnosis of AF to comprise at least 30% of the study cohort. Assuming an average baseline OAC use of 60% and a post-intervention use of 70% with a post-control rate of 60%, there will be roughly 94-98% power with 25 clusters per group (intracluster correlation coefficient of 0.02). While this trial focuses on improving treatment use and reducing preventable strokes, we also aim to better understand the reasons for OAC underuse. This will improve the intervention with the goal of creating educational recommendations to improve care for patients with AF.

Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes: Insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation Registry

Significant racial/ethnic differences exist in the incidence of atrial fibrillation (AF). However, less is known about racial/ethnic differences in quality of life (QoL), treatment, and outcomes associated with AF. Using data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we compared clinical characteristics, QoL, management strategies, and long-term outcomes associated with AF among various racial/ethnic groups. We analyzed 9,542 participants with AF (mean age 74 ± 11 years, 43% women, 91% white, 5% black, 4% Hispanic) from 174 centers. Compared with AF patients identified as white race, patients identified as Hispanic ethnicity and those identified as black race were younger, were more often women, and had more cardiac and noncardiac comorbidities. Black patients were more symptomatic with worse QoL and were less likely to be treated with a rhythm control strategy than other racial/ethnic groups. There were no significant racial/ethnic differences in CHA2DS2-VASc stroke or ATRIA bleeding risk scores and rates of oral anticoagulation use were similar. However, racial and ethnic minority populations treated with warfarin spent a lower median time in therapeutic range of international normalized ratio (59% blacks vs 68% whites vs 62% Hispanics, P < .0001). There was no difference in long-term outcomes associated with AF between the 3 groups at a median follow-up of 2.1 years. Relative to white and Hispanic patients, black patients with AF had more symptoms, were less likely to receive rhythm control interventions, and had lower quality of warfarin management. Despite these differences, clinical events at 2 years were similar by race and ethnicity.

Oral Anticoagulation for Stroke Prevention in Canadian Practice: Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) Registry*

BackgroundWe explored patterns of and factors associated with the use of oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) in contemporary Canadian practice. MethodsPhase 1 of the Stroke Prevention and Rhythm Intervention in Atrial Fibrillation (SPRINT-AF) registry was a cross-sectional retrospective study of patients with nonvalvular AF (NVAF). From December 2012-July 2013, 936 consecutive patients with NVAF were enrolled in SPRINT-AF. Of the 782 patients treated with OAC, the proportion treated with warfarin and a new oral anticoagulant (NOAC) was 53.2% and 46.8%, respectively. The rate of OAC use was 90.9% among patients with a CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score ≥ 2. ResultsOn multivariable analysis, the 2 strongest factors associated with NOAC use (compared with warfarin use) were an improved side effect profile (as perceived by the patient) and improved efficacy (as perceived by the physician) (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.06-0.17; P < 0.01 and OR, 0.52; 95% CI, 0.36-0.76; P < 0.01, respectively). Lower cost was strongly associated with warfarin use (OR, 5.16; 95% CI, 3.49-7.63; P < 0.01). ConclusionsIn this contemporary Canadian AF registry, the rate of guideline-concordant OAC use was high. About half of OAC-treated patients received NOACs. Patient- and physician-driven preferences, such as side effect profile, perceived greater efficacy, and cost, were strong determinants of NOAC use over warfarin use.