4K-6 USING AN ATRIAL FIBRILLATION DECISION SUPPORT TOOL (AFDST) FOR THROMBOPROPHYLAXIS IN ATRIAL FIBRILLATION: IMPACT OF GENDER AND AGE

Tuesday, October 20, 2015: 2:45 PM
Grand Ballroom B (Hyatt Regency St. Louis at the Arch)

Mark Eckman, MD, MS1, Gregory Lip, MD2, Ruth Wise, MSN, MDes1, Anthony Leonard, PhD3, Barbara Speer, BS3, Megan Sullivan, MS4, Nita Walker, MD5, Matthew Flaherty, MD6, Brett Kissela, MD, MS7, Peter Baker, BS8, Dawn Kleindorfer, MD6, John Kues, PhD9, Robert Ireton, BS8, Dave Hoskins8, Brett Harnett, MS-IS8, Carlos Aguilar, MD, MS10, Lora Arduser, PhD11, Dylan Steen, MD12 and Alexandru Costea, MD12, (1)University of Cincinnati, Division of General Internal Medicine and Center for Clinical Effectiveness, Cincinnati, OH, (2)University of Birmingham, Birmingham, United Kingdom, (3)University of Cincinnati, Department of Family and Community Medicine, Cincinnati, OH, (4)UC Health, Cincinnati, OH, (5)University of Cincinnati, Division of General Internal Medicine, Cincinnati, OH, (6)University of Cincinnati, Department of Neurology, Cincinnati, OH, (7)University of Cincinnati, Cincinnati, OH, (8)University of Cincinnati, Department of Biomedical Informatics, Center for Health Informatics, Cincinnati, OH, (9)University of Cincinnati, Department of Community and Family Medicine, Cincinnati, OH, (10)University of Cincinnati, Division of General Internal Medicine and Center for Health Informatics, Cincinnati, OH, (11)University of Cincinnati, Department of English, Cincinnati, OH, (12)University of Cincinnati, Division of Cardiology, Cincinnati, OH
Purpose: Among patients with atrial fibrillation (AF), female gender has been associated with both an increased risk of stroke and paradoxically a decreased likelihood of receiving anticoagulant therapy. There also is a perception that the elderly are less likely to receive anticoagulant therapy due to concerns about falling and frailty. We wished to assess the appropriateness of antithrombotic therapy among women and the elderly, looking for patterns of either under-treatment or unnecessary treatment.

Method: Retrospective cohort study of 1,586 adults with non-valvular AF or flutter seen in primary care settings of an integrated healthcare system between December 2012 and March 2014. Treatment recommendations were made by an Atrial Fibrillation Decision Support Tool (AFDST) based on projections for QALE calculated by a decision analytic model that integrates patient-specific risk factors for stroke and hemorrhage and examines strategies of no antithrombotic therapy, aspirin, or oral anticoagulation.

Result:

Current treatment was discordant from recommended treatment in 45% (326/725) of women and in 39% (338/860) of men (p = 0.02). Among the elderly (age ≥ 85) current treatment was discordant from recommended treatment in 35% (89/258), while treatment was discordant among 43% (575/1328) of patients < 85 years of age (p = < 0.01). We further examined age categories in 5-year increments and found that discordant therapy was as high as 60-70% in those between the ages of 31 and 50. Among 326 women with discordant treatment 99% (322/326) was due to under-treatment and 1% (4/326) was due to overtreatment. Among 338 men with discordant treatment 81% (274/338) was due to under-treatment, while 19% (64/338) was due to overtreatment. Among 89 elderly patients with discordant treatment 98% (87/89) of discordance was due to under-treatment and 2% (2/89) was due to overtreatment, whereas in those < 85 years of age, 88% (509/575) was due to under-treatment and 12% (66/575) of was due to overtreatment.

Conclusion:

Women are still undertreated with antithrombotic therapy for AF. Somewhat surprisingly, compared with older patients, a larger proportion of patients < 85 years of age are receiving treatment that is discordant from recommended therapy. Furthermore, in women and the elderly the major reason for discordant therapy is under-treatment; whereas in men and younger patients, a larger proportion of discordance is due to overtreatment.

See more of: ORAL ABSTRACTS: APPLICATIONS IN OUTCOMES RESEARCH AND POLICY

See more of: 37th Annual Meeting of the Society for Medical Decision Making