Newly Diagnosed Atrial Fibrillation Benefits From Cardiology Care vs Primary Care

Cardiology care was associated with improved outcomes in patients with newly diagnosed atrial fibrillation (AF), according to a retrospective study published in the Journal of the American College of Cardiology.

Researchers collected data from the TREAT-AF (Retrospective Evaluation and Assessment of Therapies in AF) study, which included 184,161 patients treated in the Veterans Affairs healthcare system (mean age, 70 years; mean CHA₂DS₂-VASc score, 2.6±1.7) who were newly diagnosed with AF between 2004 and 2012 with at least 1 outpatient visit to a primary care or cardiology provider within 90 days of diagnosis. Of these patients, 40% received cardiology care and 60% received primary care only.

Cardiology care was associated with reductions in stroke (hazard ratio [HR], 0.91; 95% CI, 0.86-0.96; P <.001) and death (HR, 0.89; 95% CI, 0.88-0.91; P <.0001), as well as increases in hospitalizations for AF/supraventricular tachycardia (HR, 1.38; 95% CI, 1.35-1.42; P <.0001) and myocardial infarction (HR, 1.03; 95% CI, 1.00-1.05; P <.04), after adjustment for covariates.

In addition, patients who received cardiology care had a higher number of 90-day receipt of oral anticoagulation therapy sessions compared with patients who received only primary care (70.3% vs 58.8%; P <.0001) as well as AF control agents (90.1% vs 80.5%; P <.0001), AF rhythm control agents (20.8% vs 11.0%; P <.0001), and other cardiovascular medications (eg, antiplatelet agents [42.6% vs 28.6%; P <.0001], statins [65.6% vs 58.1%; P <.0001), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers [66.0% vs 57.5%; P <.0001]).

The researchers noted that although the higher prescription rate of oral anticoagulants in patients who received cardiology care may have prevented strokes, it did not reduce mortality.

“These findings warrant serious consideration of care pathways for patients with AF soon after diagnosis, identification of additional mediators of improved outcomes and exploration into the scalability of these interventions across healthcare settings, and innovative healthcare delivery models,” the researchers concluded.

Study Limitations

• The study was observational in design
• Cardiology care may be a marker, not a cause, of improved patient health status, including lifestyle factors such as diet and exercise
• The researchers could not be certain regarding non-Veterans Affairs specialty care, which may have led to a misclassification of primary care-only patients if, for example, they received cardiology care using private insurance
• The majority of the study population was male

Reference

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Perino AC, Fan J, Schmitt SK, et al. Treating specialty and outcomes in newly diagnosed atrial fibrillation. J Am Coll Cardiol. 2017;70(1):78-86. doi:10.1016/j.jacc.2017.04.054