Background:Stroke prophylaxis in patients with atrial fibrillation (AF) and heart failure (HF) in the era of direct oral anticoagulants is not well characterized. Using data from American Heart Association Get With The Guidelines–AFIB, we sought to evaluate oral anticoagulation (OAC) use at discharge among AF patients with concomitant HF.Methods and Results:AF patients with a diagnosis of HF hospitalized from January 2013 to March 2017 were included. We compared patient characteristics and use of OAC at discharge among patients with reduced (redundant ejection fraction [EF], EF≤40%), borderline (40%<EF<50%), and preserved (EF≥50%) EF using multivariable mixed logistic regression models. Among 10 883 patients with AF and HF, 1790 (16.4%) had a reported contraindication to anticoagulation and were excluded from further analysis. Among 9093 patients eligible for OAC, 3499 (38.5%) had HF with reduced EF, 1062 (11.7%) had HF with borderline EF, and 4532 (49.8%) had HF with preserved EF. The median CHA₂DS₂-VASc score was 5 (Q1, Q3; 3, 6) among all patients and higher among those with HF with preserved EF than HF with reduced EF (5 [4, 6] versus 4 [3, 5]; P<0.0001). The proportion of eligible patients discharged on OAC was 94.9%, with 43.6% discharged on warfarin and 50.7% discharged on direct oral anticoagulants. A higher proportion of patients with HF with reduced EF and HF with borderline EF were discharged on direct oral anticoagulants than with HF with preserved EF, but the difference was small (52.8%, 53.1% versus 48.5%, respectively; P=0.0002). EF group was not significantly associated with a patient’s OAC use at discharge.Conclusions:In the context of American Heart Association Get With The Guidelines–AFIB, a quality improvement program, the rate of use of OAC at discharge in eligible AF patients with HF was almost 95%. To our knowledge, these rates represent some of the highest use of appropriate anticoagulation for patients in a national registry to date.

中文翻译：

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口服抗凝药在符合条件的心力衰竭和心房纤颤患者中的应用

背景：在直接口服抗凝剂时代对房颤（AF）和心力衰竭（HF）的患者的卒中预防尚无很好的特征。我们使用美国心脏协会《 AFIB指南》的数据，评估了伴发HF的房颤患者出院时口服抗凝药物（OAC）的使用。方法和结果：2013年1月至2017年3月住院诊断为HF的房颤患者被包括在内。我们使用多变量比较了射血分数降低（冗余射血分数[EF]，EF≤40％），临界值（40％<EF <50％）和保留（EF≥50％）EF的患者的特征和出院时使用OAC的情况。混合逻辑回归模型。在10883例AF和HF患者中，有1790例（16.4％）有抗凝禁忌症报道，被排除在进一步分析之外。在9093名符合OAC资格的患者中，有3499名（38.5％）的HF伴有EF降低，有1062名（11.7％）的HF伴有临界EF，而4532名（49.8％）的HF伴有EF保留。中位数CHA在所有患者中，₂ DS ₂ -VASc评分均为5（Q1，Q3； 3、6），在EF保留的HF患者中，EF降低的HF患者得分更高（5 [4，6]对4 [3，5]；P <0.0001）。通过OAC出院的合格患者比例为94.9％，其中华法林出院率为43.6％，直接口服抗凝剂出院率为50.7％。EF降低的HF患者和EF临界的HF患者经口服直接抗凝治疗后出院的比例高于EF保留的HF患者，但差异很小（分别为52.8％，53.1％和48.5％；P= 0.0002）。EF组与出院时OAC的使用无显着相关性。结论：在美国心脏协会质量改善指南AFIB的背景下，合格AF房颤患者出院时OAC的使用率为几乎95％。据我们所知，这些比率代表了迄今为止在国家级注册机构中对患者进行适当抗凝治疗的最高使用率。