Use of Oral Anticoagulation in a Real‐World Population With Device Detected Atrial Fibrillation

BACKGROUND: Guideline recommendations for oral anticoagulation (OAC) in patients with atrial fibrillation (AF) are based on CHA(2)DS(2)‐VASc score alone. Patients with cardiac implantable electronic devices provide an opportunity to assess how the interaction between AF duration and CHA(2)DS(2)‐VASc score influences OAC prescription rates. METHODS AND RESULTS: Data from the Optum de‐identified Electronic Health Record data set were linked to the Medtronic CareLink database of cardiac implantable electronic devices. An index date was assigned as the later of 6 months after device implant or 1 year after Electronic Health Record data availability. Maximum daily AF duration (no AF, 6 minutes–23.5 hours, and >23.5 hours) was assessed for 6 months before index date. OAC prescription rates were computed as a function of both AF duration and CHA(2)DS(2)‐VASc score. A total of 35 779 patients with CHA(2)DS(2)‐VASc scores ≥1 were identified, including 27 198 not prescribed OAC. Overall OAC prescription rate among the 12 938 patients with device‐detected AF >6 minutes was 36.7% and significantly higher in those with a maximum daily AF duration >23.5 hours (45.4%) compared with those with 6 minutes to 23.5 hours (28.7%). OAC prescription rates increased monotonically with both increasing AF duration and CHA(2)DS(2)‐VASc score, reaching a maximum of 67.2% for patients with AF >23.5 hours and a CHA(2)DS(2)‐VASc score ≥5. CONCLUSIONS: Real‐world prescription of OAC increased with both increasing duration of AF and CHA(2)DS(2)‐VASc score. This highlights the need for further research into the role of AF duration, stroke risk, and the need for anticoagulation in patients with devices capable of long‐term AF monitoring.