Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry

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art_APENTENG_Determinants_and_clinical_outcomes_of_patients_who_refused_2023.PDF (1.84 MB)
Citações na Scopus
2
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
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Título do Volume
Editora
BMJ PUBLISHING GROUP
Autores
APENTENG, Patricia
VIRDONE, Saverio
CAMM, John
FOX, Keith A. A.
BASSAND, Jean-Pierre
TURPIE, Alexander G. G.
OH, Seil
BRODMANN, Marianne
COOLS, Frank
Citação
OPEN HEART, v.10, n.1, article ID e002275, 10p, 2023
Projetos de Pesquisa
Unidades Organizacionais
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Resumo
ObjectiveThere is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician's choice, however, a proportion of AF patients refuse anticoagulation. The aim of our study was to investigate factors associated with patient refusal of anticoagulation and the clinical outcomes in these patients.MethodsOur study population comprised patients in the Global Anticoagulant Registry in the FIELD (GARFIELD-AF) registry with CHA(2)DS(2)-VASc >= 2. A logistic regression was developed with predictors of patient anticoagulation refusal identified by least absolute shrinkage and selection operator methodology. Patient demographics, medical and cardiovascular history, lifestyle factors, vital signs (body mass index, pulse, systolic and diastolic blood pressure), type of AF and care setting at diagnosis were considered as potential predictors. We also investigated 2-year outcomes of non-haemorrhagic stroke/systemic embolism (SE), major bleeding and all-cause mortality in patients who refused versus patients who received and patients who did not receive anticoagulation for other reasons.ResultsOut of 43 154 AF patients, who were at high risk of stroke, 13 283 (30.8%) did not receive anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13 283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Diagnosis in primary care/general practitioner, Asian ethnicity and presence of vascular disease were strongly associated with a higher risk of patient refusal of anticoagulation. Patient refusal of anticoagulation was associated with a higher risk of non-haemorrhagic stroke/SE (adjusted HR (aHR) 1.16 (95% CI 0.77 to 1.76)) but lower all-cause mortality (aHR 0.59 (95% CI 0.43 to 0.80)) compared with patients who received anticoagulation. The GARFIELD-AF mortality score corroborated this result.ConclusionThe data suggest patient refusal of anticoagulation is a missed opportunity to prevent AF-related stroke. Further research is required to understand the patient profile and mortality outcome of patients who refuse anticoagulation.
Palavras-chave
Atrial Fibrillation, Drug Monitoring, Stroke
URI
https://observatorio.fm.usp.br/handle/OPI/53866
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - ODS/03