Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR ®) PINNACLE Registry
Thompson, Lauren E.
Maddox, Thomas M.
Grunwald, Gary K.
Bradley, Steven M.
Peterson, Pamela N.
Masoudi, Frederick A.
Davis, Melinda B.
Daugherty, Stacie L.Note: Order does not necessarily reflect citation order of authors.
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CitationThompson, L. E., T. M. Maddox, L. Lei, G. K. Grunwald, S. M. Bradley, P. N. Peterson, F. A. Masoudi, et al. 2017. “Sex Differences in the Use of Oral Anticoagulants for Atrial Fibrillation: A Report From the National Cardiovascular Data Registry (NCDR ®) PINNACLE Registry.” Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 6 (7): e005801. doi:10.1161/JAHA.117.005801. http://dx.doi.org/10.1161/JAHA.117.005801.
AbstractBackground: Despite higher thromboembolism risk, women with atrial fibrillation have lower oral anticoagulation (OAC) use compared to men. The influence of the CHA 2 DS 2‐VASc score or the introduction of non–vitamin K OACs on this relationship is not known. Methods and Results: Using the PINNACLE National Cardiovascular Data Registry from 2008 to 2014, we compared the association of sex with OAC use (warfarin or non–vitamin K OACs) overall and by CHA 2 DS 2‐VASc score and examined temporal trends in OAC use by sex. Multivariable regression models assessed the association between sex and OAC use in those with CHA 2 DS 2‐VASc scores ≥2. Temporal analyses assessed changes in OAC use by sex over time. Of the 691 906 atrial fibrillation patients, 48.5% were women. Women were significantly less likely than men to use any OAC overall (56.7% versus 61.3%; P<0.001) and at all levels of CHA 2 DS 2‐VASc score (adjusted risk ratio 9% to 33% lower, all P<0.001). Compared to other thromboembolic risk factors, female sex was associated with lower use of OAC (risk ratio 0.90, 95%CI 0.90‐0.91). Over time, non–vitamin K OAC use increased at a slightly higher rate in women (56.2% increase per year, 95%CI 54.6% to 57.9%) compared to men (53.6% increase per year, 95%CI 52.0% to 55.2%), yet women remained less likely to receive any OAC at all time points (P<0.001). Conclusions: Among patients with atrial fibrillation, women were significantly less likely to receive OAC at all levels of the CHA 2 DS 2‐VASc score. Despite increasing non–vitamin K OAC use, women had persistently lower rates of OAC use compared to men over time.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:34491880
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