Impact of CHA₂DS₂VASc Score on Candidacy for Anticoagulation in Patients With Atrial Fibrillation: A Multi-payer Analysis

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• 作者：Aarti A. Patel ; PharmD ; MBA ; ^{apatel15@its.jnj.com" class="auth_mail" title="E-mail the corresponding author} ; Winnie W. Nelson ; PharmD ; MS ; MBA ; Jeff Schein ; DrPH ; MPH
• 关键词：anticoagulant ; atrial fibrillation ; risk assessment ; stroke prevention
• 刊名：Clinical Therapeutics
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：38
• 期：10
• 页码：2196-2203.e5
• 全文大小：344 K

文摘

The purpose of this study is to report on the effect of using CHA₂DS₂VASc (congestive heart failure, hypertension, age ≥75 years [doubled], type 1 or type 2 diabetes mellitus, stroke or transient ischemic attack or thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65–75 years, sex category [female]) rather than CHADS₂ (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke) to determine candidacy for anticoagulant prophylaxis in insured patients with atrial fibrillation (AF).

Methods

Six administrative claims databases that included medical and pharmacy claims for patients aged ≥18 years with a new or existing diagnosis of AF and patient outcomes assessed for 1 year after diagnosis were analyzed. Retrospective health plan data analyses were performed using a software tool (Anticoagulant Quality Improvement Analyzer). Study measures included stroke risk (identified by CHADS₂ and CHA₂DS₂VASc scores), bleeding risk (identified by the Anticoagulation and Risk Factors in Atrial Fibrillation score), and anticoagulant use.

Findings

A total of 115,906 patients with AF (range of mean ages among the 6 databases, 56–79 years) met the inclusion criteria. All ranges reported represent the minimum and maximum values among the 6 databases. Using the CHA₂DS₂VASc compared with the CHADS₂ index to assess stroke risk resulted in a 23% to 32% increase in patients considered potential candidates for anticoagulant prophylaxis. This translated to a 38% to 114% increase in the number of ostensibly undertreated patients. Among patients with high stroke and low bleeding risk, 18% to 28% more patients were considered potential candidates for anticoagulation treatment using CHA₂DS₂VASc compared with CHADS₂, or a 57% to 151% increase in the number of undertreated patients.

Implications

Use of the CHA₂DS₂VASc score to determine the risk of stroke increased the number of AF patients for whom oral anticoagulation would be recommended. Additional research is needed to determine whether this paradigm shift to greater use of oral anticoagulants improves patient outcomes.