Document Type


Publication Date


Publication Title





Introduction: Oral anticoagulant (OAC) therapy significantly reduces the risk of thromboembolism among at-risk patients with atrial fibrillation (AF). Current guidelines provide strong support for an OAC in men and women with AF and CHA2DS2-VASc scores of >2 and >3, respectively. In spite of this, previous data has suggested that up to 40% of these patients are not treated in accordance with guideline recommendations.

Hypothesis: We hypothesized that OAC therapy continues to remain significantly underutilized among at-risk patients with AF in real-world settings.

Methods: We sought to evaluate the prevalence of OAC underuse and contributing factors in an ambulatory population of at-risk AF patients within a large multistate healthcare system. EHR and coding (ICD-10) data were used to identify patients with AF, calculate their CHA2DS2-VASc score, and define their current antithrombotic regimen. Demographics were assessed to allow for comparison between those receiving an OAC from those who were not. Chi square or Fisher exact tests were used to examine differences between groups.

Results: Data was pulled from our EHR on 8/1/18, identifying 147,455 unique patients with AF, of which 102,728 (76.3%) had a CHA2DS2-VASc score >2 (excluding female gender) (Table). Compared to those on an OAC, patients on antiplatelet therapy were more likely to have coronary artery disease, peripheral vascular disease, and prior MI (p

Conclusions: In a contemporary, non-registry setting, OAC underuse remains substantial among at-risk patients with AF. Further investigation into tools that facilitate implementation of guideline-directed medical therapy is needed to limit preventable thromboembolic events in this population.

Clinical Institute

Cardiovascular (Heart)




Center for Cardiovascular Analytics, Research + Data Science (CARDS)

Included in

Cardiology Commons