{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T08:13:40Z","timestamp":1771661620559,"version":"3.50.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004826","name":"Beijing Natural Science Foundation","doi-asserted-by":"publisher","award":["Z141100002114050"],"award-info":[{"award-number":["Z141100002114050"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Chinese Military Health Care","award":["17BJZ08"],"award-info":[{"award-number":["17BJZ08"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,28]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Adherence to guideline-directed oral anticoagulation (OAC) in patients with atrial fibrillation (AF) improves outcomes, but limited data are available from China. We evaluated the adherence to guideline-directed anticoagulation and its impact on clinical outcomes in a high-risk cohort of elderly Chinese patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>The Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry is a prospective, multicentre study conducted from October 2014 to December 2018. Endpoints of interest were all-cause death, thromboembolic (TE) events and major bleedings in patients with a guideline-directed indication for OACs (CHA2DS2-VASc \u22651 if male or \u22652 if female). The eligible cohort consisted of 5742 patients, of whom 2567 (44.7%) patients were treated with an OAC. Seven independent predictors of OAC undertreatment were identified: age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.03\u20131.05; P\u00a0&amp;lt;\u00a00.001], first diagnosed AF (OR: 1.71; 95%CI: 1.44\u20132.03; P\u00a0&amp;lt;\u00a00.001), chronic kidney disease (OR: 1.67; 95%CI: 1.36\u20132.06; P\u00a0&amp;lt;\u00a00.001), liver disease (OR: 1.69; 95%CI: 1.19\u20132.41; P\u00a0=\u00a00.003), dementia (OR: 1.67; 95%CI: 1.06\u20132.64; P\u00a0=\u00a00.026), prior extracranial bleeding (OR: 1.89; 95%CI: 1.35\u20132.64; P\u00a0&amp;lt;\u00a00.001), and the use of antiplatelet drug (OR: 6.97; 95%CI: 5.89\u20138.23; P\u00a0&amp;lt;\u00a00.001). On multivariate analysis, OAC undertreatment was significantly associated with a higher risk all-cause death (OR: 3.79; 95%CI: 2.61\u20135.53; P\u00a0&amp;lt;\u00a00.001) and TE events (OR: 2.28; 95%CI: 1.39\u20133.72; P\u00a0=\u00a00.001), and a similar risk of major bleeding as compared with guideline-directed OAC therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Only 44.7% of all eligible patients were prescribed OAC in accordance with guideline recommendations. The independent predictors for OAC undertreatment were age, first diagnosed AF, chronic kidney disease, chronic obstructive pulmonary disease, prior extracranial bleeding, and the use of the antiplatelet drugs. Guideline-adherent thromboprophylaxis was safe and may be associated with improved survival and less TE among elderly Chinese patients with AF.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcab054","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T19:13:02Z","timestamp":1628017982000},"page":"169-176","source":"Crossref","is-referenced-by-count":26,"title":["Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation: a report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7626-7751","authenticated-orcid":false,"given":"Yutao","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Centre, Chinese PLA General Hospital , Beijing 100142, China"},{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital , Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6762-3187","authenticated-orcid":false,"given":"Agnieszka","family":"Kotalczyk","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital , Liverpool, UK"},{"name":"Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia , Silesian Centre for Heart Diseases, Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo F","family":"Imberti","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital , Liverpool, UK"},{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Policlinico di Modena, Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Medical Centre, Chinese PLA General Hospital , Beijing 100853, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Centre, Chinese PLA General Hospital , Beijing 100142, China"},{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital , Liverpool, UK"},{"name":"Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University , Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ChiOTEAF Registry Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/nrcardio.2017.153","article-title":"The ABC pathway: an integrated approach to improve AF management","volume":"14","author":"Lip","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the Europea","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.joa.2017.05.004","article-title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation","volume":"33","author":"Chiang","year":"2017","journal-title":"J Arrhythmia"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1160\/TH17-08-0555","article-title":"Regional Differences in antithrombotic treatment for atrial fibrillation: Insights from the GLORIA-AF Phase II Registry","volume":"117","author":"Mazurek","year":"2017","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.acvd.2014.01.001","article-title":"Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: insights from the International RealiseAF Survey","volume":"107","author":"Gamra","year":"2014","journal-title":"Arch Cardiovasc Dis"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.mayocp.2017.05.023","article-title":"Guideline-adherent antithrombotic treatment improves outcomes in patients with atrial fibrillation: insights from the community-based Darlington Atrial Fibrillation Registry","volume":"92","author":"Mazurek","year":"2017","journal-title":"Mayo Clin Proc"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1161\/STROKEAHA.120.029295","article-title":"Adherence to anticoagulant guideline for atrial fibrillation improves outcomes in Asian population","volume":"51","author":"Krittayaphong","year":"2020","journal-title":"Stroke"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"30734","DOI":"10.1038\/srep30734","article-title":"European Society of Cardiology Guideline\u2014adherent antithrombotic treatment and risk of mortality in Asian patients with atrial fibrillation","volume":"6","author":"Li","year":"2016","journal-title":"Sci Rep"},{"key":"2023022812201208100_","first-page":"1777","article-title":"Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry","volume":"17","author":"Lip","year":"2015","journal-title":"EP Eur"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1136\/heartjnl-2016-309741","article-title":"Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom","volume":"102","author":"Senoo","year":"2016","journal-title":"Heart"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/s-0040-1718729","article-title":"The East Asian paradox: an updated position statement on the challenges to the current antithrombotic strategy in patients with cardiovascular disease","volume":"121","author":"Kim","year":"2021","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.ijcard.2012.09.187","article-title":"Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: would the novel oral anticoagulants have an impact?","volume":"168","author":"Guo","year":"2013","journal-title":"Int J Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1253\/circj.CJ-14-0720","article-title":"Impact of non-vitamin k antagonist oral anticoagulants on intracranial bleeding in Asian patients with non-valvular atrial fibrillation","volume":"78","author":"Yasaka","year":"2014","journal-title":"Circ J"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.ijcard.2014.11.182","article-title":"Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: time for a reappraisal","volume":"180","author":"Lip","year":"2015","journal-title":"Int J Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"e020191","DOI":"10.1136\/bmjopen-2017-020191","article-title":"Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry: protocol for a prospective, observational nationwide cohort study","volume":"8","author":"Guo","year":"2018","journal-title":"BMJ Open"},{"key":"2023022812201208100_","first-page":"308","article-title":"A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry","volume":"16","author":"Lip","year":"2014","journal-title":"EP Eur"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"key":"2023022812201208100_","volume-title":"Cerebrovascular disorders: a clinical and research classification","author":"Organization WH","year":"1978"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1161\/STROKEAHA.108.192218","article-title":"Definition and evaluation of transient ischemic attack","volume":"40","author":"Easton","year":"2009","journal-title":"Stroke"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1161\/STROKEAHA.116.012988","article-title":"Current status and time trends of oral anticoagulation use among Chinese patients with nonvalvular atrial fibrillation: The Chinese Atrial Fibrillation Registry Study","volume":"47","author":"Chang","year":"2016","journal-title":"Stroke"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S0140-6736(07)61233-1","article-title":"Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial","volume":"370","author":"Mant","year":"2007","journal-title":"Lancet"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/ageing\/afl129","article-title":"A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO)","volume":"36","author":"Rash","year":"2007","journal-title":"Age Ageing"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.1161\/STROKEAHA.115.009947","article-title":"Non-vitamin K antagonist oral anticoagulants for stroke prevention in Asian patients with nonvalvular atrial fibrillation","volume":"46","author":"Wang","year":"2015","journal-title":"Stroke"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1055\/s-0040-1716752","article-title":"Satisfaction of patients with nonvitamin K anticoagulants compared to vitamin K antagonists: a systematic review and meta-analysis","volume":"121","author":"Katerenchuk","year":"2021","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.3390\/jcm9061969","article-title":"Persistence with anticoagulation for atrial fibrillation: report from the GLORIA-AF Phase III 1-year follow-up","volume":"9","author":"Kozie\u0142","year":"2020","journal-title":"J Clin Med"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"99","DOI":"10.3904\/kjim.2017.415","article-title":"A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a comparison study of drugs for symptom control and complication prevention of atrial fibrillation (CODE-AF)","volume":"35","author":"Kim","year":"2020","journal-title":"Korean J Intern Med"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1055\/s-0040-1702231","article-title":"The compelling issue of nonvitamin K antagonist oral anticoagulant adherence in atrial fibrillation patients: a systematic need for new strategies","volume":"120","author":"Proietti","year":"2020","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1055\/s-0039-1697954","article-title":"NOAC adherence of patients with atrial fibrillation in the real world: dosing frequency matters?","volume":"120","author":"Hwang","year":"2020","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","article-title":"Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries","author":"Komen","journal-title":"EP Eur"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/s41569-020-00459-3","article-title":"Stroke prevention strategies in high-risk patients with atrial fibrillation","volume":"18","author":"Kotalczyk","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1055\/s-0039-1688482","article-title":"Anticoagulation for atrial fibrillation in older adults\u2014using big data for big questions","volume":"119","author":"Quinn","year":"2019","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","article-title":"Age-dependent anticoagulant therapy for atrial fibrillation patients with intermediate risk of ischemic stroke: a nationwide population-based study","author":"Choi","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1093\/eurheartj\/ehy837","article-title":"Age threshold for the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation: insights into the optimal assessment of age and incident comorbidities","volume":"40","author":"Chao","year":"2019","journal-title":"Eur Heart J"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/S0735-1097(19)30898-8","article-title":"How much atrial fibrillation is too much? Treatment benefit of anticoagulation based on threshold of device-detected Af","volume":"73","author":"Perino","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"e017024","DOI":"10.1161\/JAHA.120.017024","article-title":"Management of atrial fibrillation in older patients by morbidity burden: insights from get with the guidelines-atrial fibrillation","volume":"9","author":"Dalgaard","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.jacc.2020.01.052","article-title":"Mobile health technology to improve care for patients with atrial fibrillation","volume":"75","author":"Guo","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2023022812201208100_","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0040-1716408","article-title":"The 4S-AF scheme (stroke risk; symptoms; severity of burden; substrate): a novel approach to in-depth characterization (rather than classification) of atrial fibrillation","volume":"121","author":"Potpara","year":"2021","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","article-title":"Adherence to the \u201catrial fibrillation better care\u201d (ABC) pathway in patients with atrial fibrillation","author":"Romiti","journal-title":"Thromb Haemost"},{"key":"2023022812201208100_","first-page":"1013","article-title":"Association between antithrombotic treatment and outcomes at 1-year follow-up in patients with atrial fibrillation: the EORP-AF General Long-Term Registry","volume":"21","author":"Boriani","year":"2019","journal-title":"EP Eur"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcab054\/41271108\/qcab054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/9\/2\/169\/49351472\/qcab054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/9\/2\/169\/49351472\/qcab054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T21:29:11Z","timestamp":1699306151000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/9\/2\/169\/6346598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,9]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,8,9]]},"published-print":{"date-parts":[[2023,2,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcab054","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3]]},"published":{"date-parts":[[2021,8,9]]}}}