title: European Society of Cardiology Guideline-Adherent Antithrombotic Treatment and Risk of Mortality in Asian Patients with Atrial Fibrillation.
abstract: This study compared the risk of mortality in atrial fibrillation (AF) patients treated adherent to the 2012 European Society of Cardiology (ESC) guidelines for stroke prevention and those who were not treated according to guideline recommendations. This study used the Taiwan National Health Insurance Research Database. From 1996 to 2011, 354,649 newly diagnosed AF patients were identified as the study population. Among the study cohort, 45,595 and 309,054 patients were defined as Guideline-Adherent and Non-Adherent groups, respectively. During the follow up of 1,480,280 person-years, 133,552 (37.7%) patients experienced mortality. The risk of mortality was lower among AF patients whose treatment was adherent to the guideline recommendation for stroke prevention than those whose treatment was not (annual risk of mortality = 4.3% versus 10.0%) with an adjusted hazard ratio of 0.62 (95% confidence interval = 0.61-0.64, p value < 0.001) after adjusting for age, gender, CHA2DS2-VASc score and antiplatelet therapy. The findings were consistently observed after propensity matching analysis. In conclusion, the risk of mortality was lower for AF patients who were treated according to the antithrombotic recommendations of the 2012 ESC guidelines, guided by the CHA2DS2-VASc score. Better efforts to implement guidelines would lead to improved outcomes for patients with AF.
authors: Division of Electrophysiology, Cardiovascular Center, Taichung Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
authors: Cheng-Hung
authors: CH
authors: Li
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Chia-Jen
authors: CJ
authors: Liu
authors: Division of Cardiology, Department of Medicine, Lions Gate Hospital, North Vancouver, British Columbia, Canada.
authors: Annie Y
authors: AY
authors: Chou
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tze-Fan
authors: TF
authors: Chao
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Ta-Chuan
authors: TC
authors: Tuan
authors: Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Su-Jung
authors: SJ
authors: Chen
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Kang-Ling
authors: KL
authors: Wang
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Shih-Lin
authors: SL
authors: Chang
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Li-Wei
authors: LW
authors: Lo
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Yu-Feng
authors: YF
authors: Hu
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Fa-Po
authors: FP
authors: Chung
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Jo-Nan
authors: JN
authors: Liao
authors: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Division of Electrophysiology, Cardiovascular Center, Taichung Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
authors: Tsu-Juey
authors: TJ
authors: Wu
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D057216:Propensity Score; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000991:Antithrombins