Cardiac implantable device diagnosis of atrial fibrillation (AF) is associated with an increased risk of stroke; however, the level of AF burden at which oral anticoagulation (OAC) therapy is initiated is unclear.
This is a retrospective cohort study in which Veterans Health Administration linked remote monitoring (AF burden in days) data were analyzed. Patients with a CHA2DS2-VASc score ≥2 points from 2011 to 2014, no stroke or OAC prescription in the past 2 years, and a cardiac implantable device with remote monitoring function. To determine the percentage of OAC prescriptions within 90 days of first device diagnosis of AF (AF diagnosis from ≥6 minutes to 24 hours).
0, 212 patients had cardiac implantable devices, 4570 patients (45%) had AF for 6 minutes; 3969 patients (39%) had AF for 1 hour; 3263 patients (32%) had AF for 6 hours; 2469 patients (24%) had AF for 24 hours .
AF 1 hour Among the patients, 1712 met the inclusion criteria, age 72±10 years, 1.5% female, CHA2DS2-VASc score 4.0±1.4, HAS-BLED score 2.6±1.1.
The relationship between the percentage of OAC prescriptions and the time to diagnosis of AF varies greatly, ≥6 minutes: 272/2101 [13%]; 1 hour: 273/1712 [16%]; 6 hours: 263/1279 [21%]; 24 hours: 224/ 818 [27%]. In the
adjusted model, OAC prescription was associated with a reduced risk of stroke in those with 24 hours of AF (HR 0.28, 95% CI, 0.10–0.81; P=0.02).
Device diagnosis of AF is common among veterans with cardiac implantable devices. OAC prescription rates were low within 90 days of first device diagnosis of AF, even among patients with AF within 24 hours.
The patient screening process is shown in the figure below,
AF The OAC prescription rate in different medical centers in 1 hour is shown in the figure below,
The comparison of different AF diagnosis times is shown in the table below,
The relationship between stroke incidence and AF diagnosis time is shown in the figure below,
AF diagnosis time and OAC The relationship between prescription and prognosis is shown in the table below,
The relationship between OAC prescription rate and prognosis is shown in the table below,
Circulation. 2019;139:2502–2512.
