The number of patients with a common type of heart arrhythmia who cannot be treated with the therapeutic standard of care is significant, and they are at an increased risk for stroke, according to a new study co-authored by William A. Gray, MD, system chief of the division of cardiovascular disease at Main Line Health.
Atrial fibrillation (AF) is a cardiac arrhythmia that affects one in 25 adults age 60 and older, and one in 10 in those age 80 and older. Untreated AF is associated with a markedly increased risk of stroke—in fact, it accounts for 15 percent to 30 percent all of strokes, according to scientific studies.
But not all patients can take the oral anticoagulant (OAC) medications that are the standard of care for AF because of a history for or a risk of life-threatening bleeding episodes. Dr. Gray and his colleagues set out to determine the scope of the problem. They ascertained the percentage of AF patients who cannot take OAC and then characterized their risk of stroke.
By studying U.S. health insurance claims data from 2009 through 2013, the researchers identified more than 1.3 million patients with AF, of which more than 43,000 had a contraindication event or a clearly defined increased bleeding risk and were not on OAC for at least one year, or they has passed away when hospitalized. In that cohort of AF patients not on OAC, 4.1 percent had an ischemic stroke, and 3.6 percent had a hemorrhagic stroke—which represents a roughly three-fold increase compared to patients able to take OAC. Also in that same cohort, those with a prior history of intracranial bleeding (within the skull) had markedly increased incidences of ischemic and hemorrhagic stroke of 12.2 percent and 20.3 percent respectively.
“These findings likely confirmed many physicians’ clinical impression of some of the AF population,” said Dr. Gray, who is also a clinical professor at the Lankenau Institute for Medical Research, part of Main Line Health. “A significant portion of patients diagnosed with AF are unable to take the stroke prophylactic OAC medications available, and the accompanying risk of stroke among these patients is high and in line with historical data. Consideration of currently available treatment alternatives that provide stroke prevention for this population is a reasonable approach for such patients.”
The researchers’ results were published in the manuscript “Patients with atrial fibrillation who are not on anticoagulant treatment due to increased bleeding risk are common and have a high risk of stroke” in the biomedical journal JACC: Clinical Electrophysiology. An abstract is available at sciencedirect.com.
Founded in 1985, Main Line Health is a not-for-profit health system serving Philadelphia and its western suburbs. Main Line Health's commitment—to deliver advanced medicine for treating and curing disease, playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to be the region's premier choice for clinical care, research, and education. A team of more than 10,000 employees, 3,000 nurses and 2,000 physicians care for patients throughout the Main Line Health System.
At Main Line Health's core are four of the region's most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation's premier facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.
Main Line Health also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton, King of Prussia and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare, one of the region's largest multispecialty physician networks.
Main Line Health is the recipient of numerous awards for quality care, and service, including U.S. News & World Report's Best Hospitals, System Magnet® designation; the nation's highest distinction for nursing excellence and the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award. Main Line Health is committed to creating an environment of diversity, respect, equity, and inclusion, has proudly received awards in this area and has embraced the American Hospital Association's #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education, and research to help patients stay healthy and live their best lives.
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Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR's mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR's principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.