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Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry
OBJECTIVE: There is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician’s choice, however, a proportion of AF patients refuse anticoagulation. The aim of our stu...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410826/ https://www.ncbi.nlm.nih.gov/pubmed/37169491 http://dx.doi.org/10.1136/openhrt-2023-002275 |
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author | Apenteng, Patricia Virdone, Saverio Camm, John Fox, Keith A A Bassand, Jean-Pierre Turpie, Alexander G G Oh, Seil Brodmann, Marianne Cools, Frank Barretto, Antonio C P Nielsen, Jørn Haas, Sylvia Kayani, Gloria Pieper, Karen S Kakkar, Ajay K |
author_facet | Apenteng, Patricia Virdone, Saverio Camm, John Fox, Keith A A Bassand, Jean-Pierre Turpie, Alexander G G Oh, Seil Brodmann, Marianne Cools, Frank Barretto, Antonio C P Nielsen, Jørn Haas, Sylvia Kayani, Gloria Pieper, Karen S Kakkar, Ajay K |
author_sort | Apenteng, Patricia |
collection | PubMed |
description | OBJECTIVE: There is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician’s choice, however, a proportion of AF patients refuse anticoagulation. The aim of our study was to investigate factors associated with patient refusal of anticoagulation and the clinical outcomes in these patients. METHODS: Our study population comprised patients in the Global Anticoagulant Registry in the FIELD (GARFIELD-AF) registry with CHA(2)DS(2)-VASc≥2. A logistic regression was developed with predictors of patient anticoagulation refusal identified by least absolute shrinkage and selection operator methodology. Patient demographics, medical and cardiovascular history, lifestyle factors, vital signs (body mass index, pulse, systolic and diastolic blood pressure), type of AF and care setting at diagnosis were considered as potential predictors. We also investigated 2-year outcomes of non-haemorrhagic stroke/systemic embolism (SE), major bleeding and all-cause mortality in patients who refused versus patients who received and patients who did not receive anticoagulation for other reasons. RESULTS: Out of 43 154 AF patients, who were at high risk of stroke, 13 283 (30.8%) did not receive anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13 283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Diagnosis in primary care/general practitioner, Asian ethnicity and presence of vascular disease were strongly associated with a higher risk of patient refusal of anticoagulation. Patient refusal of anticoagulation was associated with a higher risk of non-haemorrhagic stroke/SE (adjusted HR (aHR) 1.16 (95% CI 0.77 to 1.76)) but lower all-cause mortality (aHR 0.59 (95% CI 0.43 to 0.80)) compared with patients who received anticoagulation. The GARFIELD-AF mortality score corroborated this result. CONCLUSION: The data suggest patient refusal of anticoagulation is a missed opportunity to prevent AF-related stroke. Further research is required to understand the patient profile and mortality outcome of patients who refuse anticoagulation. |
format | Online Article Text |
id | pubmed-10410826 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-104108262023-08-10 Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry Apenteng, Patricia Virdone, Saverio Camm, John Fox, Keith A A Bassand, Jean-Pierre Turpie, Alexander G G Oh, Seil Brodmann, Marianne Cools, Frank Barretto, Antonio C P Nielsen, Jørn Haas, Sylvia Kayani, Gloria Pieper, Karen S Kakkar, Ajay K Open Heart Special Populations OBJECTIVE: There is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician’s choice, however, a proportion of AF patients refuse anticoagulation. The aim of our study was to investigate factors associated with patient refusal of anticoagulation and the clinical outcomes in these patients. METHODS: Our study population comprised patients in the Global Anticoagulant Registry in the FIELD (GARFIELD-AF) registry with CHA(2)DS(2)-VASc≥2. A logistic regression was developed with predictors of patient anticoagulation refusal identified by least absolute shrinkage and selection operator methodology. Patient demographics, medical and cardiovascular history, lifestyle factors, vital signs (body mass index, pulse, systolic and diastolic blood pressure), type of AF and care setting at diagnosis were considered as potential predictors. We also investigated 2-year outcomes of non-haemorrhagic stroke/systemic embolism (SE), major bleeding and all-cause mortality in patients who refused versus patients who received and patients who did not receive anticoagulation for other reasons. RESULTS: Out of 43 154 AF patients, who were at high risk of stroke, 13 283 (30.8%) did not receive anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13 283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Diagnosis in primary care/general practitioner, Asian ethnicity and presence of vascular disease were strongly associated with a higher risk of patient refusal of anticoagulation. Patient refusal of anticoagulation was associated with a higher risk of non-haemorrhagic stroke/SE (adjusted HR (aHR) 1.16 (95% CI 0.77 to 1.76)) but lower all-cause mortality (aHR 0.59 (95% CI 0.43 to 0.80)) compared with patients who received anticoagulation. The GARFIELD-AF mortality score corroborated this result. CONCLUSION: The data suggest patient refusal of anticoagulation is a missed opportunity to prevent AF-related stroke. Further research is required to understand the patient profile and mortality outcome of patients who refuse anticoagulation. BMJ Publishing Group 2023-05-11 /pmc/articles/PMC10410826/ /pubmed/37169491 http://dx.doi.org/10.1136/openhrt-2023-002275 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Special Populations Apenteng, Patricia Virdone, Saverio Camm, John Fox, Keith A A Bassand, Jean-Pierre Turpie, Alexander G G Oh, Seil Brodmann, Marianne Cools, Frank Barretto, Antonio C P Nielsen, Jørn Haas, Sylvia Kayani, Gloria Pieper, Karen S Kakkar, Ajay K Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title | Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title_full | Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title_fullStr | Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title_full_unstemmed | Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title_short | Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry |
title_sort | determinants and clinical outcomes of patients who refused anticoagulation: findings from the global garfield-af registry |
topic | Special Populations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410826/ https://www.ncbi.nlm.nih.gov/pubmed/37169491 http://dx.doi.org/10.1136/openhrt-2023-002275 |
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