Clinical outcomes, management, healthcare resource utilization, and cost according to the CHA2DS2-VASc scores in Asian patients with nonvalvular atrial fibrillation.

Abstract

Background: The prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA₂DS₂-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients.

Methods and results: This retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022. Patients were stratified into 3 cohorts by CHA₂DS₂-VASc scores: low-risk, intermediate-risk, and high-risk. One-year incidence rates and cumulative incidence of clinical outcomes (including ischemic stroke [IS], transient ischemic attack [TIA], arterial embolism [AE], and major bleeding [MB]) were calculated. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1 % female), 16,541 (3.9 %) were classified as low-risk, 38,494 (9.2 %) as intermediate-risk, and 364,455 (86.9 %) as high-risk. The one-year incidence rates for IS, TIA, AE, and MB were 12.4 (95 % CI, 12.3-12.5), 1.1 (95 % CI, 1.0-1.1), 0.5 (95 % CI, 0.5-0.5), and 3.1 per 100 person-years (95 % CI, 3.1-3.2), with an increasing trend from the low-risk to the high-risk group, respectively. During follow-up, 16.4 % and 11.1 % of patients in the low-risk and high-risk cohorts received oral anticoagulants (OACs), respectively. In addition, significant differences in HCRU and cost were observed in these three cohorts.

Conclusion: This study demonstrates that contemporary Asian NVAF patients with higher CHA₂DS₂-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. Additionally, suboptimal management was present across all CHA2DS2-VASc score groups.