title: Oral Anticoagulation for Stroke Prevention in Canadian Practice: Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) Registry(.).
abstract: BACKGROUND
  We explored patterns of and factors associated with the use of oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) in contemporary Canadian practice.
  
  
  METHODS
  Phase 1 of the Stroke Prevention and Rhythm Intervention in Atrial Fibrillation (SPRINT-AF) registry was a cross-sectional retrospective study of patients with nonvalvular AF (NVAF). From December 2012-July 2013, 936 consecutive patients with NVAF were enrolled in SPRINT-AF. Of the 782 patients treated with OAC, the proportion treated with warfarin and a new oral anticoagulant (NOAC) was 53.2% and 46.8%, respectively. The rate of OAC use was 90.9% among patients with a CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score ≥ 2.
  
  
  RESULTS
  On multivariable analysis, the 2 strongest factors associated with NOAC use (compared with warfarin use) were an improved side effect profile (as perceived by the patient) and improved efficacy (as perceived by the physician) (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.06-0.17; P < 0.01 and OR, 0.52; 95% CI, 0.36-0.76; P < 0.01, respectively). Lower cost was strongly associated with warfarin use (OR, 5.16; 95% CI, 3.49-7.63; P < 0.01).
  
  
  CONCLUSIONS
  In this contemporary Canadian AF registry, the rate of guideline-concordant OAC use was high. About half of OAC-treated patients received NOACs. Patient- and physician-driven preferences, such as side effect profile, perceived greater efficacy, and cost, were strong determinants of NOAC use over warfarin use.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew C T
authors.initials: AC
authors.lastname: Ha
authors.affiliation: Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Narendra
authors.initials: N
authors.lastname: Singh
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jafna L
authors.initials: JL
authors.lastname: Cox
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: University of Montreal, Montreal, Québec, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: Fournier
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Lockwood
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.affiliation: Canadian Cardiovascular Research Network, Brampton, Ontario, Canada.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kajil
authors.affiliation: Canadian Cardiovascular Research Network, Brampton, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Tsigoulis
authors.affiliation: Canadian Cardiovascular Research Network, Brampton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada. Electronic address: mkgupta@ccrnmd.com.
authors.forename: Milan K
authors.initials: MK
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants