Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-AB22 - Implantable Loop Recorders in Electrophysiology Practice! (ID 51) Abstract

D-AB22-01 - Initiation Of Oral Anticoagulation In Patients With An Insertable Cardiac Monitor: Results From The Reveal Linq Registry (ID 1452)

Abstract

Background: Current clinical guidelines for the management of patients with AF recommend using the CHA2DS2-VASc score for risk stratification of thromboembolic risk and need for oral anticoagulation therapy (OAC). However, the influence of AF duration on the decision to initiate OAC is unknown.
Objective: To assess the impact of daily AF duration and CHA2DS2-VASc score on the decision to initiate OAC in patients with an insertable cardiac monitor (ICM).
Methods: Patients from the prospective, ongoing, multi-center Reveal LINQ Registry not receiving an OAC at time of ICM implantation were eligible for this analysis if they initiated OAC or were monitored for > 6 months. The maximum daily duration of AF was assessed from ICM implantation to OAC initiation or last follow-up. Logistic regression was used to model the data.
Results: In total, 961 patients (Figure) were included (59±18 years, 53% male, mean CHA2DS2-VASc score 2.5 + 1.8). During a mean follow-up of 20 + 9 months, OAC was started in 169 (18%) patients. OAC initiation was more likely in patients with higher daily AF duration (p<0.0001) and higher score (p<0.0001, Figure). Once the daily AF duration exceeded 6 hours, nearly 50% of even low risk patients (score = 0 or 1) received an OAC. In contrast, >23.5 hours of daily AF duration did not necessarily lead to OAC initiation, even in patients with a high score.
Conclusion: This analysis reflecting real-world practice in patients monitored by an ICM, shows that daily AF duration influenced OAC therapy initiation beyond just the CHA2DS2-VASc scores. A significant number of low risk-patients were placed on OAC, whereas a number of high-risk patients were not prescribed OAC.
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