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Anticoagulation in patients with atrial fibrillation and heart failure: Insights from the NCDR PINNACLE-AF registry.


ABSTRACT:

Background

In non-valvular atrial fibrillation (NVAF) patients, congestive heart failure (CHF) confers an increased risk of stroke or systemic thromboembolism. This risk is present in both heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). It is unclear if clinicians account for both types of CHF in their NVAF anticoagulation practices. Accordingly, we characterized current outpatient anticoagulation trends in NVAF patients with HFpEF compared to patients with HFrEF.

Methods

The outpatient NCDR PINNACLE-AF registry was analyzed to identify patients with NVAF and CHF. The study population was subdivided into HFpEF (ie, LVEF???40%) and HFrEF (LVEF?2 DS2 -VASc score.

Results

A total of 340?127 patients with NVAF and CHF were identified, of whom 248?136 (73.0%) were classified as HFpEF and 91?991 (27.0%) as HFrEF. Patients with HFpEF had higher mean CHA2 DS2 -VASc scores and were more likely to be female, older, and have hypertension (P 2 DS2 -VASc score demonstrated that lower rates of anticoagulation in patients with HFpEF persisted until a score of ?5.

Conclusions

Patients with NVAF and HFpEF have significantly lower anticoagulation rates when compared to their HFrEF counterparts. These findings suggest a potential underappreciation of HFpEF as a risk factor in patients with NVAF.

SUBMITTER: Contreras JP 

PROVIDER: S-EPMC6712307 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Anticoagulation in patients with atrial fibrillation and heart failure: Insights from the NCDR PINNACLE-AF registry.

Contreras Johanna P JP   Hong Kimberly N KN   Castillo Javier J   Marzec Lucas N LN   Hsu Jonathan C JC   Cannon Christopher P CP   Yang Song S   Maddox Thomas M TM  

Clinical cardiology 20190130 3


<h4>Background</h4>In non-valvular atrial fibrillation (NVAF) patients, congestive heart failure (CHF) confers an increased risk of stroke or systemic thromboembolism. This risk is present in both heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). It is unclear if clinicians account for both types of CHF in their NVAF anticoagulation practices. Accordingly, we characterized current outpatient anticoagulation trends in NVAF patients with HFp  ...[more]

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