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D. Vinereanu, H.R. Al-Khalidi, M.P. Rao, R.L. Lopes, C.M. Bahit, A.O. Ciobanu, S.D. Pokorney, Y. Xian, J. Jiang, D.Y. Kamath, O. Berwanger, C. Tajer, Y. Huo, D. Xavier, C.B. Granger, P3631
Determinants of antithrombotic treatment of patients with AF: baseline characteristics from a clustered randomized trial to IMProve treatment with AntiCoagulanTs in patients with AF (IMPACT-AF), European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx504.P3631, https://doi.org/10.1093/eurheartj/ehx504.P3631Close - Share Icon Share
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Background: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there are few contemporary comparative data on AF from middle-income countries.
Methods: Baseline characteristics of the IMPACT-AF trial were analyzed in order to assess regional differences in presentation and antithrombotic treatment of AF from five middle-income countries (Argentina, Brazil, China, India, and Romania) and factors associated with prescription of antithrombotic treatment. Characteristics assessed were: (1) demographics; (2) medical history; (3) risk factors for stroke; (4) antithrombotic treatment; and (5) main reasons for not prescribing anticoagulation treatment.
Results: The IMPACT-AF trial enrolled 2285 patients (69±11 years, 47% women) at 48 sites. Overall, 66% of patients were on anticoagulation at baseline, ranging from 37% in China to 91% in Brazil. The top three reasons for not prescribing an anticoagulant were reported to be patient preference/refusal (30%), concomitant antiplatelet therapy (17%), and risks outweighing the benefits, as assessed by the physician (15%). In a multivariable logistic model, the most significant factors associated with prescription of oral anticoagulants were no prior major bleeding (OR=4.0; 95% CI=2.2–7.1), no alcohol abuse (OR=2.2; 95% CI=1.1–4.4), and history of rheumatic valvular heart disease (OR=2.1; 95% CI=1.3–3.2), with a strong predictive accuracy (C-statistic=0.85) (Figure A), whereas the most significant factors associated with prescription of a combination of oral anticoagulants and antiplatelet drugs were prior coronary revascularization (OR=4.9; 95% CI=2.8–8.5), no alcohol abuse (OR=2.2; 95% CI=1.1–4.6), and prior myocardial infarction (OR=2.2; 95% CI=1.4–3.5), with a good predictive accuracy (C-statistic=0.76) (Figure B).
