Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

Standard

Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings. / Mikkelsen, Anders Pretzmann; Hansen, Morten Lock; Olesen, Jonas Bjerring; Hvidtfeldt, Morten Winther; Karasoy, Deniz; Husted, Steen; Johnsen, Søren Paaske; Brandes, Axel; Gislason, Gunnar; Torp-Pedersen, Christian; Lamberts, Morten.

I: Europace, Bind 18, Nr. 4, 2016, s. 492-500.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

Harvard

Mikkelsen, AP, Hansen, ML, Olesen, JB, Hvidtfeldt, MW, Karasoy, D, Husted, S, Johnsen, SP, Brandes, A, Gislason, G, Torp-Pedersen, C & Lamberts, M 2016, 'Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings', Europace, bind 18, nr. 4, s. 492-500. https://doi.org/10.1093/europace/euv242

APA

Mikkelsen, A. P., Hansen, M. L., Olesen, J. B., Hvidtfeldt, M. W., Karasoy, D., Husted, S., Johnsen, S. P., Brandes, A., Gislason, G., Torp-Pedersen, C., & Lamberts, M. (2016). Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings. Europace, 18(4), 492-500. https://doi.org/10.1093/europace/euv242

Vancouver

Mikkelsen AP, Hansen ML, Olesen JB, Hvidtfeldt MW, Karasoy D, Husted S o.a. Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings. Europace. 2016;18(4):492-500. https://doi.org/10.1093/europace/euv242

Author

Mikkelsen, Anders Pretzmann ; Hansen, Morten Lock ; Olesen, Jonas Bjerring ; Hvidtfeldt, Morten Winther ; Karasoy, Deniz ; Husted, Steen ; Johnsen, Søren Paaske ; Brandes, Axel ; Gislason, Gunnar ; Torp-Pedersen, Christian ; Lamberts, Morten. / Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings. I: Europace. 2016 ; Bind 18, Nr. 4. s. 492-500.

Bibtex

@article{5272c0673e814a1d861ced8402d11ff9,

title = "Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings",

abstract = "AIMS: Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting.METHODS AND RESULTS: Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients with a CHADS2 ≥ 2 was 42.1, 63.0, and 32.4%, respectively. Initiation of OAC therapy was only modestly influenced by CHADS2 and HAS-BLED scores, regardless of the healthcare setting. The rate of TE was 4.30 [95% confidence interval (CI) 4.21-4.40] per 100 person-years for inpatients, 2.28 (95% CI 2.22-2.36) for outpatients, and 2.30 (95% CI 2.05-2.59) for ED patients. The adjusted HR of TE, with inpatients as reference, was 0.74 (95% CI 0.71-0.77) for outpatients and 0.89 (95% CI 0.79-1.01) for ED patients.CONCLUSION: In a nationwide cohort of non-valvular AF patients, outpatients were much more likely to receive OAC therapy and had a significantly lower risk of stroke/TE compared with inpatients and ED patients. However, across all settings investigated, OAC therapy was far from optimal.",

keywords = "Journal Article",

author = "Mikkelsen, {Anders Pretzmann} and Hansen, {Morten Lock} and Olesen, {Jonas Bjerring} and Hvidtfeldt, {Morten Winther} and Deniz Karasoy and Steen Husted and Johnsen, {S{\o}ren Paaske} and Axel Brandes and Gunnar Gislason and Christian Torp-Pedersen and Morten Lamberts",

year = "2016",

doi = "10.1093/europace/euv242",

language = "English",

volume = "18",

pages = "492--500",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "4",

}

RIS

TY - JOUR

T1 - Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings

AU - Mikkelsen, Anders Pretzmann

AU - Hansen, Morten Lock

AU - Olesen, Jonas Bjerring

AU - Hvidtfeldt, Morten Winther

AU - Karasoy, Deniz

AU - Husted, Steen

AU - Johnsen, Søren Paaske

AU - Brandes, Axel

AU - Gislason, Gunnar

AU - Torp-Pedersen, Christian

AU - Lamberts, Morten

PY - 2016

Y1 - 2016

N2 - AIMS: Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting.METHODS AND RESULTS: Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients with a CHADS2 ≥ 2 was 42.1, 63.0, and 32.4%, respectively. Initiation of OAC therapy was only modestly influenced by CHADS2 and HAS-BLED scores, regardless of the healthcare setting. The rate of TE was 4.30 [95% confidence interval (CI) 4.21-4.40] per 100 person-years for inpatients, 2.28 (95% CI 2.22-2.36) for outpatients, and 2.30 (95% CI 2.05-2.59) for ED patients. The adjusted HR of TE, with inpatients as reference, was 0.74 (95% CI 0.71-0.77) for outpatients and 0.89 (95% CI 0.79-1.01) for ED patients.CONCLUSION: In a nationwide cohort of non-valvular AF patients, outpatients were much more likely to receive OAC therapy and had a significantly lower risk of stroke/TE compared with inpatients and ED patients. However, across all settings investigated, OAC therapy was far from optimal.

AB - AIMS: Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting.METHODS AND RESULTS: Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients with a CHADS2 ≥ 2 was 42.1, 63.0, and 32.4%, respectively. Initiation of OAC therapy was only modestly influenced by CHADS2 and HAS-BLED scores, regardless of the healthcare setting. The rate of TE was 4.30 [95% confidence interval (CI) 4.21-4.40] per 100 person-years for inpatients, 2.28 (95% CI 2.22-2.36) for outpatients, and 2.30 (95% CI 2.05-2.59) for ED patients. The adjusted HR of TE, with inpatients as reference, was 0.74 (95% CI 0.71-0.77) for outpatients and 0.89 (95% CI 0.79-1.01) for ED patients.CONCLUSION: In a nationwide cohort of non-valvular AF patients, outpatients were much more likely to receive OAC therapy and had a significantly lower risk of stroke/TE compared with inpatients and ED patients. However, across all settings investigated, OAC therapy was far from optimal.

KW - Journal Article

U2 - 10.1093/europace/euv242

DO - 10.1093/europace/euv242

M3 - Journal article

C2 - 26443443

VL - 18

SP - 492

EP - 500

JO - Europace

JF - Europace

SN - 1099-5129

IS - 4

ER -

ID: 164441838