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Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR ® ) PINNACLE Registry.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2017 Jul 19; Vol. 6 (7). Date of Electronic Publication: 2017 Jul 19. - Publication Year :
- 2017
-
Abstract
- Background: Despite higher thromboembolism risk, women with atrial fibrillation have lower oral anticoagulation (OAC) use compared to men. The influence of the CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score or the introduction of non-vitamin K OACs on this relationship is not known.<br />Methods and Results: Using the PINNACLE National Cardiovascular Data Registry from 2008 to 2014, we compared the association of sex with OAC use (warfarin or non-vitamin K OACs) overall and by CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score and examined temporal trends in OAC use by sex. Multivariable regression models assessed the association between sex and OAC use in those with CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores ≥2. Temporal analyses assessed changes in OAC use by sex over time. Of the 691 906 atrial fibrillation patients, 48.5% were women. Women were significantly less likely than men to use any OAC overall (56.7% versus 61.3%; P <0.001) and at all levels of CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score (adjusted risk ratio 9% to 33% lower, all P <0.001). Compared to other thromboembolic risk factors, female sex was associated with lower use of OAC (risk ratio 0.90, 95%CI 0.90-0.91). Over time, non-vitamin K OAC use increased at a slightly higher rate in women (56.2% increase per year, 95%CI 54.6% to 57.9%) compared to men (53.6% increase per year, 95%CI 52.0% to 55.2%), yet women remained less likely to receive any OAC at all time points ( P <0.001).<br />Conclusions: Among patients with atrial fibrillation, women were significantly less likely to receive OAC at all levels of the CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score. Despite increasing non-vitamin K OAC use, women had persistently lower rates of OAC use compared to men over time.<br /> (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Subjects :
- Administration, Oral
Aged
Aged, 80 and over
Atrial Fibrillation complications
Atrial Fibrillation diagnosis
Chi-Square Distribution
Decision Support Techniques
F Factor
Female
Hemorrhage chemically induced
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Registries
Risk Factors
Stroke diagnosis
Stroke etiology
Thromboembolism diagnosis
Thromboembolism etiology
United States
Anticoagulants administration & dosage
Atrial Fibrillation drug therapy
Healthcare Disparities trends
Practice Patterns, Physicians' trends
Stroke prevention & control
Thromboembolism prevention & control
Warfarin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 6
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 28724655
- Full Text :
- https://doi.org/10.1161/JAHA.117.005801