title: Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation.
abstract: BACKGROUND
  Patients with atrial fibrillation often have cardiovascular risk factors or known comorbid disease, yet the use of evidence-based primary and secondary prevention cardiac therapy among atrial fibrillation outpatients is unknown.
  
  
  METHODS
  Using baseline data collected between June 2010 and August 2011 from 174 sites participating in ORBIT-AF, a US national registry of patients with atrial fibrillation coordinated from Durham, NC, we examined professional guideline-recommended evidence-based therapy use for cardiovascular comorbid conditions and risk factors. Multivariable logistic regression was used to identify factors associated with receipt of all indicated evidence-based therapy.
  
  
  RESULTS
  Among 10,096 enrolled patients, 93.5% were eligible for one or more evidence-based therapies. Among those eligible, 46.6% received all indicated therapies: 62.3% received an antiplatelet agent, 72.3% received a beta-blocker, 59.5% received an angiotensin-converting enzyme or angiotensin receptor blocker, 15.3% received an aldosterone antagonist, 65.7% received a statin, and 58.8% received an implantable cardioverter-defibrillator. A minority of patients with coronary artery disease, diabetes mellitus, heart failure, and peripheral vascular disease received all indicated therapies (25.1%, 43.2%, 42.5%, and 43.4%, respectively). A total of 52.4% of patients had controlled hypertension and 74.6% of patients with hyperlipidemia received a statin. Factors associated with nonreceipt of all indicated therapies included frailty, comorbid illness, geographic region, and antiarrhythmic drug therapy.
  
  
  CONCLUSIONS
  The majority of eligible atrial fibrillation outpatients did not receive all guideline-recommended therapies for cardiovascular comorbid conditions and risk factors. This represents a potential opportunity to improve atrial fibrillation patients' quality of care and outcomes.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27715, USA. p.hess@duke.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hess
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Jack E
authors.initials: JE
authors.lastname: Ansell
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.forename: James V
authors.initials: JV
authors.lastname: Freeman
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012042:Registries; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors