Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation: A Nationwide Cohort Study

Tze Fan Chao, Chia Jen Liu, Ta Chuan Tuan, Kang Ling Wang, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Tzeng Ji Chen, Chern En Chiang, Ming Hsiung Hsieh, Gregory Y H Lip, Shih Ann Chen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective To investigate the impact on outcomes of changing treatment guideline recommendations by comparing the proportion of patients with atrial fibrillation (AF) recommended oral anticoagulants (OACs) under the 2011 and 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Patients and Methods We used the "National Health Insurance Research Database" in Taiwan, which included 354,649 patients with AF from January 1, 1996 through December 31, 2011. Patients with a CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or more and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex category) score of 2 or more were considered to have a definitive indication for receiving OACs according to the 2011 and 2014 ACC/AHA guidelines, respectively. Results The percentages of patients with AF recommended OACs increased from 69.3% (n=245,598) under the 2011 guideline to 86.7% (n=307,640) under the new 2014 guidelines, an increment of 17.5% (95% CI, 17.4-17.6). Most women with AF (94.1%) and patients older than 65 years (97.2%) would receive OACs on the basis of the 2014 guidelines. Among patients previously not being recommended OACs in older guidelines, OAC use under the new guidelines was associated with a lower risk of adverse outcomes (ischemic stroke or intracranial hemorrhage or bleeding requiring blood transfusion or mortality) with an adjusted hazard ratio of 0.89 (95% CI, 0.85-0.94). Conclusion In this nationwide cohort study, use of the 2014 guidelines led more patients with AF to receive OACs for stroke prevention, and this increased OAC use was associated with better outcomes. Better efforts to implement guidelines would lead to improved outcomes for patients with AF.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalMayo Clinic Proceedings
Volume91
Issue number5
DOIs
Publication statusPublished - May 1 2016

Fingerprint

Atrial Fibrillation
Cohort Studies
Stroke
Anticoagulants
Guidelines
Transient Ischemic Attack
Diabetes Mellitus
Heart Failure
Hypertension
American Heart Association
Intracranial Hemorrhages
National Health Programs
Cardiology
Taiwan
Vascular Diseases
Blood Transfusion
Databases
Hemorrhage
Mortality
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation : A Nationwide Cohort Study. / Chao, Tze Fan; Liu, Chia Jen; Tuan, Ta Chuan; Wang, Kang Ling; Lin, Yenn Jiang; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Chen, Tzeng Ji; Chiang, Chern En; Hsieh, Ming Hsiung; Lip, Gregory Y H; Chen, Shih Ann.

In: Mayo Clinic Proceedings, Vol. 91, No. 5, 01.05.2016, p. 567-574.

Research output: Contribution to journalArticle

Chao, TF, Liu, CJ, Tuan, TC, Wang, KL, Lin, YJ, Chang, SL, Lo, LW, Hu, YF, Chen, TJ, Chiang, CE, Hsieh, MH, Lip, GYH & Chen, SA 2016, 'Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation: A Nationwide Cohort Study', Mayo Clinic Proceedings, vol. 91, no. 5, pp. 567-574. https://doi.org/10.1016/j.mayocp.2016.03.007
Chao, Tze Fan ; Liu, Chia Jen ; Tuan, Ta Chuan ; Wang, Kang Ling ; Lin, Yenn Jiang ; Chang, Shih Lin ; Lo, Li Wei ; Hu, Yu Feng ; Chen, Tzeng Ji ; Chiang, Chern En ; Hsieh, Ming Hsiung ; Lip, Gregory Y H ; Chen, Shih Ann. / Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation : A Nationwide Cohort Study. In: Mayo Clinic Proceedings. 2016 ; Vol. 91, No. 5. pp. 567-574.
@article{e89af7e84b844296b7caf25a841bc01c,
title = "Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation: A Nationwide Cohort Study",
abstract = "Objective To investigate the impact on outcomes of changing treatment guideline recommendations by comparing the proportion of patients with atrial fibrillation (AF) recommended oral anticoagulants (OACs) under the 2011 and 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Patients and Methods We used the {"}National Health Insurance Research Database{"} in Taiwan, which included 354,649 patients with AF from January 1, 1996 through December 31, 2011. Patients with a CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or more and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex category) score of 2 or more were considered to have a definitive indication for receiving OACs according to the 2011 and 2014 ACC/AHA guidelines, respectively. Results The percentages of patients with AF recommended OACs increased from 69.3{\%} (n=245,598) under the 2011 guideline to 86.7{\%} (n=307,640) under the new 2014 guidelines, an increment of 17.5{\%} (95{\%} CI, 17.4-17.6). Most women with AF (94.1{\%}) and patients older than 65 years (97.2{\%}) would receive OACs on the basis of the 2014 guidelines. Among patients previously not being recommended OACs in older guidelines, OAC use under the new guidelines was associated with a lower risk of adverse outcomes (ischemic stroke or intracranial hemorrhage or bleeding requiring blood transfusion or mortality) with an adjusted hazard ratio of 0.89 (95{\%} CI, 0.85-0.94). Conclusion In this nationwide cohort study, use of the 2014 guidelines led more patients with AF to receive OACs for stroke prevention, and this increased OAC use was associated with better outcomes. Better efforts to implement guidelines would lead to improved outcomes for patients with AF.",
author = "Chao, {Tze Fan} and Liu, {Chia Jen} and Tuan, {Ta Chuan} and Wang, {Kang Ling} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Lo, {Li Wei} and Hu, {Yu Feng} and Chen, {Tzeng Ji} and Chiang, {Chern En} and Hsieh, {Ming Hsiung} and Lip, {Gregory Y H} and Chen, {Shih Ann}",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.mayocp.2016.03.007",
language = "English",
volume = "91",
pages = "567--574",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "5",

}

TY - JOUR

T1 - Impact on Outcomes of Changing Treatment Guideline Recommendations for Stroke Prevention in Atrial Fibrillation

T2 - A Nationwide Cohort Study

AU - Chao, Tze Fan

AU - Liu, Chia Jen

AU - Tuan, Ta Chuan

AU - Wang, Kang Ling

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Chen, Tzeng Ji

AU - Chiang, Chern En

AU - Hsieh, Ming Hsiung

AU - Lip, Gregory Y H

AU - Chen, Shih Ann

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Objective To investigate the impact on outcomes of changing treatment guideline recommendations by comparing the proportion of patients with atrial fibrillation (AF) recommended oral anticoagulants (OACs) under the 2011 and 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Patients and Methods We used the "National Health Insurance Research Database" in Taiwan, which included 354,649 patients with AF from January 1, 1996 through December 31, 2011. Patients with a CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or more and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex category) score of 2 or more were considered to have a definitive indication for receiving OACs according to the 2011 and 2014 ACC/AHA guidelines, respectively. Results The percentages of patients with AF recommended OACs increased from 69.3% (n=245,598) under the 2011 guideline to 86.7% (n=307,640) under the new 2014 guidelines, an increment of 17.5% (95% CI, 17.4-17.6). Most women with AF (94.1%) and patients older than 65 years (97.2%) would receive OACs on the basis of the 2014 guidelines. Among patients previously not being recommended OACs in older guidelines, OAC use under the new guidelines was associated with a lower risk of adverse outcomes (ischemic stroke or intracranial hemorrhage or bleeding requiring blood transfusion or mortality) with an adjusted hazard ratio of 0.89 (95% CI, 0.85-0.94). Conclusion In this nationwide cohort study, use of the 2014 guidelines led more patients with AF to receive OACs for stroke prevention, and this increased OAC use was associated with better outcomes. Better efforts to implement guidelines would lead to improved outcomes for patients with AF.

AB - Objective To investigate the impact on outcomes of changing treatment guideline recommendations by comparing the proportion of patients with atrial fibrillation (AF) recommended oral anticoagulants (OACs) under the 2011 and 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Patients and Methods We used the "National Health Insurance Research Database" in Taiwan, which included 354,649 patients with AF from January 1, 1996 through December 31, 2011. Patients with a CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or more and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex category) score of 2 or more were considered to have a definitive indication for receiving OACs according to the 2011 and 2014 ACC/AHA guidelines, respectively. Results The percentages of patients with AF recommended OACs increased from 69.3% (n=245,598) under the 2011 guideline to 86.7% (n=307,640) under the new 2014 guidelines, an increment of 17.5% (95% CI, 17.4-17.6). Most women with AF (94.1%) and patients older than 65 years (97.2%) would receive OACs on the basis of the 2014 guidelines. Among patients previously not being recommended OACs in older guidelines, OAC use under the new guidelines was associated with a lower risk of adverse outcomes (ischemic stroke or intracranial hemorrhage or bleeding requiring blood transfusion or mortality) with an adjusted hazard ratio of 0.89 (95% CI, 0.85-0.94). Conclusion In this nationwide cohort study, use of the 2014 guidelines led more patients with AF to receive OACs for stroke prevention, and this increased OAC use was associated with better outcomes. Better efforts to implement guidelines would lead to improved outcomes for patients with AF.

UR - http://www.scopus.com/inward/record.url?scp=84966600773&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84966600773&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2016.03.007

DO - 10.1016/j.mayocp.2016.03.007

M3 - Article

C2 - 27068667

AN - SCOPUS:84966600773

VL - 91

SP - 567

EP - 574

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 5

ER -