Assessing Potential Benefit of Stroke Prophylaxis Therapy in Atrial Fibrillation and Atrial Flutter Using a Novel...

Area of Science:

• Cardiology
• Geriatrics
• Public Health

Background:

• Atrial fibrillation (AF) patients face a competing risk of non-stroke mortality, potentially limiting stroke prophylaxis benefits.
• Identifying patients who truly benefit from anticoagulation is crucial for optimizing treatment strategies.

Purpose of the Study:

• To develop and validate a scoring tool for stratifying patients with AF based on their potential benefit from thromboembolic prophylaxis.
• To assess the risk of stroke versus non-stroke mortality in different risk strata.

Main Methods:

• A Medicare 20% sample cohort of AF patients (2006-2019) was analyzed using ICD-9 and ICD-10 codes.
• Fine and Gray regression and Cox proportional hazard analyses were used to determine stroke and non-stroke mortality risks.
• A novel scoring tool stratified patients into low or high potential benefit groups for prophylaxis.

Main Results:

• The study included 330,136 AF patients (median age 79.7 years); 64% died and 24% had an embolic stroke over 7.3 years.
• In the high benefit group (26.1%), stroke risk exceeded non-stroke mortality risk at 1, 3, and 5 years.
• In the low benefit group (73.9%), non-stroke mortality risk significantly outweighed stroke risk at all time points.

Conclusions:

• A proposed scoring tool effectively identifies older AF patients who may benefit from thromboembolic prophylaxis.
• This tool can support shared decision-making between clinicians and patients regarding stroke prevention.
• Further research is warranted to refine and validate this scoring tool for clinical application.