Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation: a report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

AIMS: Adherence to guideline-directed oral anticoagulation (OAC) in patients with atrial fibrillation (AF) improves outcomes, but limited data are available from China. We evaluated the adherence to guideline-directed anticoagulation and its impact on clinical outcomes in a high-risk cohort of elderly Chinese patients. METHODS AND RESULTS: The Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry is a prospective, multicentre study conducted from October 2014 to December 2018. Endpoints of interest were all-cause death, thromboembolic (TE) events and major bleedings in patients with a guideline-directed indication for OACs (CHA(2)DS(2)-VASc ≥1 if male or ≥2 if female). The eligible cohort consisted of 5742 patients, of whom 2567 (44.7%) patients were treated with an OAC. Seven independent predictors of OAC undertreatment were identified: age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.03–1.05; P < 0.001], first diagnosed AF (OR: 1.71; 95%CI: 1.44–2.03; P < 0.001), chronic kidney disease (OR: 1.67; 95%CI: 1.36–2.06; P < 0.001), liver disease (OR: 1.69; 95%CI: 1.19–2.41; P = 0.003), dementia (OR: 1.67; 95%CI: 1.06–2.64; P = 0.026), prior extracranial bleeding (OR: 1.89; 95%CI: 1.35–2.64; P < 0.001), and the use of antiplatelet drug (OR: 6.97; 95%CI: 5.89–8.23; P < 0.001). On multivariate analysis, OAC undertreatment was significantly associated with a higher risk all-cause death (OR: 3.79; 95%CI: 2.61–5.53; P < 0.001) and TE events (OR: 2.28; 95%CI: 1.39–3.72; P = 0.001), and a similar risk of major bleeding as compared with guideline-directed OAC therapy. CONCLUSION: Only 44.7% of all eligible patients were prescribed OAC in accordance with guideline recommendations. The independent predictors for OAC undertreatment were age, first diagnosed AF, chronic kidney disease, chronic obstructive pulmonary disease, prior extracranial bleeding, and the use of the antiplatelet drugs. Guideline-adherent thromboprophylaxis was safe and may be associated with improved survival and less TE among elderly Chinese patients with AF.