International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation

Suarez, Jorge, Piccini, Jonathan P., Liang, Li, Atherton, John J., Hayward, Christopher S., Krum, Henry, Fonarow, Gregg C., Lopes, Renato D. and Hernandez, Adrian F. (2012) International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation. American Heart Journal, 163 5: 804-811.


Author Suarez, Jorge
Piccini, Jonathan P.
Liang, Li
Atherton, John J.
Hayward, Christopher S.
Krum, Henry
Fonarow, Gregg C.
Lopes, Renato D.
Hernandez, Adrian F.
Title International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation
Journal name American Heart Journal  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2012-05
Sub-type Article
DOI 10.1016/j.ahj.2012.02.008
Volume number 163
Issue number 5
ISSN 0002-8703; 1097-6744
Start page 804
End page 811
Total pages 8
Place of publication Philadelphia, PA, U.S.A.
Publisher Mosby
Collection year 2013
Language eng
Formatted abstract Background: We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe.

Methods: The ADHERE-International registry enrolled patients with decompensated HF from 10 Asia Pacific and Latin American countries from December 2005 to January 2009. Rates of VKA use in patients with HF and either new-onset AF or a history of AF were determined and compared according to CHADS2 scores. Multivariable logistic regression and hierarchical modeling with random effects for hospitals were used to determine clinical and regional factors associated with VKA use at discharge.

Results: Among 9,706 admissions, there were 2,358 (24.3%) with prior AF and 674 (6.9%) with new-onset AF. The median age was 71 years (25th-75th percentiles 59-79) for prior AF and 69 (57-80) for new-onset AF patients. The overall rate of VKA use at discharge was 39.5%. Vitamin K antagonist use at discharge was 36.2% in patients with CHADS2 scores ≥2 versus 50.2% in patients with CHADS2 score equal to 1 (P < .0001). Vitamin K antagonist use was 36.4% in patients with hypertension, 28.1% in patients >75 years old, 34.8% in diabetics, and 44.4% in those with prior stroke/transient ischemic attack. After adjusting for patient characteristics, the highest and lowest rates of anticoagulation were in Australia (65.2%) and Taiwan (25.1%).

Conclusion: International use of guidelines-recommended anticoagulation in HF patients with AF varies significantly across countries and represents an important opportunity for improving quality of care.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
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Created: Tue, 29 May 2012, 19:10:16 EST by Associate Professor John Atherton on behalf of Medicine - Royal Brisbane and Women's Hospital