Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. Data from the international CLARIFY registry
Bibliographic record
Abstract
Purpose: Pts with stable coronary artery disease (CAD) generally receive antiplatelet therapy, while pts with atrial fibrillation (AF) require oral anticoagulants if CHA2DS2-VASc exceeds 0. There is little data regarding the actual use of these antithrombotic strategies in CAD pts with AF in everyday practice. The goal of the present analysis was to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable CAD. Methods: CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as either prior (≥12 months) MI or revascularization procedure, or evidence of coronary stenosis of >50% or chest pain associated with proven myocardial ischaemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, the Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Results: Overall, 2237 pts (7%) had a history of known AF. Mean (SD) age in these patients was 70±9 years and median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). In this stable CAD population, there were no pts with CHA2DS2-VASc of 0. Known duration of CAD was 8 years and AF was permanent in 42% of the patients. For antithrombotic therapy, oral anticoagulation (OAC) alone was used in 26% of patients, antiplatelet therapy alone in 53% (single 42%, dual 11%) and both OAC and antiplatelet in 22%. Use of OAC was independently associated with heart failure (OR 1.50, p=0.03), lower left ventricular ejection fraction (OR 0.91 per 5% increase, p=0.001), longer history of CAD (OR 1.02 per year increase, p=0.004), no previous PCI (OR 0.64, p=0.007), lower prevalence of angina (OR 0.63, p=0.006), permanent AF (OR 4.25, p<0.0001), HAS-BLED score >2 (OR 2.67, p<0.0001) and full reimbursement for cardiovascular medication (OR 1.67, p=0.001). CHA2DS2-VASc score, multivessel CAD disease, history of MI and CABG were not significantly associated with different OAC use after adjusting for these above noted variables. Conclusions: In this contemporary international cohort of AF patients with stable CAD (all of whom are theoretical candidates for OAC), OAC were used in a minority of pts. Half of the pts received antiplatelet therapy alone and one-fifth received both antiplatelets and OAC. Thus, use of antithrombotic therapy appears to depart from contemporary guidelines. Efforts are needed to improve adherence to guidelines in this patient subset.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".