Afib: stroke risk lower when cardiologists are consulted

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Takeaway

  • Early involvement of cardiology providers in the care of adults with incident Afib may increase anticoagulant use, decrease stroke risk.

Why this matters

  • Effective anticoagulant therapy is key to stroke prevention in this population.

Key results

  • Some 61% of patients had an outpatient cardiology provider claim, whereas the rest had only primary care provider claims.
  • Patients seen by cardiology providers more often filled anticoagulant prescriptions (39% vs 27%; relative risk [RR], 1.39; 95% CI, 1.37-1.40).
  • Findings similar for direct oral anticoagulants (RR, 1.74; 95% CI, 1.71-1.78) and warfarin (Coumadin, others) (RR, 1.24; 95% CI, 1.22-1.26).
  • Patients seen by cardiology were less likely to have ischemic stroke requiring hospitalization (HR, 0.90; 95% CI, 0.86-0.94) without increased bleeding risk (HR, 1.03; 95% CI, 0.98-1.07).
  • Stroke risk also lower with cardiology care in analysis limited to patients filling prescriptions (HR, 0.83; 95% CI, 0.78-0.89).

Study design

  • Cohort study: 388,045 adults with incident Afib (mean age, 68 years).
  • Main outcomes: prescription filling; risks for stroke, bleeding.
  • Funding: National Heart, Lung, and Blood Institute; American Heart Association.

Limitations

  • Analyses relied on claims data.
  • Patients possibly saw cardiologists outside of time window.
  • Inability to account for competing risk for death.
  • Unfilled prescriptions not captured.