OAC Gap in High-Risk AF Smaller Than Previously Described

Expert adjudication of electronic medical records (EMRs) revealed that oral anticoagulants are not as underused in patients with active atrial fibrillation (AF) diagnoses as previously estimated.

“In spite of the well known recommendation, registries and systemic reviews suggest that greater than 40% of high-risk AF patients are not taking an oral anticoagulant,” Mohammed Ruzieh, MD, now of UF Health and formerly of Penn State College of Medicine, and colleagues wrote in a poster presented at the American Heart Association Scientific Sessions 2020.

However, their analysis revealed that this may be overreported.

Dr. Ruzieh and colleagues reviewed and adjudicated 6,514 patients with AF documented in EMRs. Patient charts were manually reviewed to determine if the AF diagnosis was correct and still active. Inactive AF was defined as no AF recurrence in 5 years despite no rhythm control or an episode of AF after cardiac surgery or during a systematic disease such as pneumonia or thyrotoxicosis.

Of the 6,514 patients, active AF was found in 69.9%. In contrast, about one-third (30.1%) had inaccurate diagnosis of AF or inactive AF.

Among those patients with active high-risk AF, use of oral anticoagulants was significantly higher than oral anticoagulant use in high-risk AF patients pre-adjudication (P<.0001). No difference in use was found between men and women (80.7% vs. 78.8%) with CHA2DS2-VASc >2 or in women with a CHA2DS2-VASc >3 (79.9%).

Even when counting active and inactive high-risk AF, post-adjudication oral anticoagulant use was still significantly higher (71.1% vs. 62.9%).

Finally, the expert review of EMR agreed with use of oral anticoagulants in 95% of patients with high-risk AF. Among those patients not taking oral anticoagulants, the expert review disagreed with that recommendation in 60% of cases.