{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T12:14:18Z","timestamp":1772712858592,"version":"3.50.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2019,5,28]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Device-detected atrial fibrillation (AF) is associated with increased risk of stroke; however, there are no clearly defined thresholds of AF burden at which to initiate oral anticoagulation (OAC). We sought to describe OAC prescription practice variation in response to new device-detected AF and the association with outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              We performed a retrospective cohort study using data from the Veterans Health Administration linked to remote monitoring data that included day-level AF burden. We included patients with cardiac implantable electronic devices and remote monitoring from 2011 to 2014, CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score \u22652, and no prior stroke or OAC receipt in the preceding 2 years. We determined the proportion of patients prescribed OAC within 90 days after new device-detected AF across a range of AF thresholds (\u22656 minutes to &gt;24 hours) and examined site variation in OAC prescription. We used multivariable Cox proportional hazards regressions to determine the association of OAC prescription with stroke by device-detected AF burden.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 10\u2009212 patients with cardiac implantable electronic devices, 4570 (45%), 3969 (39%), 3263 (32%), and 2469 (24%) had device-detected AF &gt;6 minutes, &gt;1 hour, &gt;6 hours, and &gt;24 hours, respectively. For device-detected AF &gt;1 hour, 1712 patients met inclusion criteria (72\u00b110 years; 1.5% female; CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score 4.0\u00b11.4; HAS-BLED score 2.6\u00b11.1). The proportion receiving OAC varied based on device-detected AF burden (\u22656 minutes: 272\/2101 [13%]; &gt;1 hour: 273\/1712 [16%]; &gt;6 hours: 263\/1279 [21%]; &gt;24 hours: 224\/818 [27%]). Across 52 sites (N=1329 patients), there was substantial site-level variation in OAC prescription after device-detected AF &gt;1 hour (median, 16%; range, 3%\u201367%; median odds ratio, 1.56 [95% credible interval, 1.49\u20131.71]). In adjusted models, OAC prescription after device-detected AF &gt;24 hours was associated with reduced stroke risk (hazard ratio, 0.28; 95% CI, 0.10\u20130.81;\n              <jats:italic>P<\/jats:italic>\n              =0.02), although the propensity-adjusted model was significant when AF lasted at least 6 minutes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among veterans with cardiac implantable electronic devices, device-detected AF is common. There is large practice variation in 90-day OAC initiation after new device-detected AF, with low rates of treatment overall, even for episodes that last &gt;24 hours. The strongest association of OAC with reduction in stroke was observed after device-detected AF &gt;24 hours. Randomized trials are needed to confirm these observational findings.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.118.038988","type":"journal-article","created":{"date-parts":[[2019,3,17]],"date-time":"2019-03-17T13:25:19Z","timestamp":1552829119000},"page":"2502-2512","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":99,"title":["Practice Variation in Anticoagulation Prescription and Outcomes After Device-Detected Atrial Fibrillation"],"prefix":"10.1161","volume":"139","author":[{"given":"Alexander C.","family":"Perino","sequence":"first","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (A.C.P., P.A.H., M.P.T.)."},{"name":"Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., M.A., P.A.H., M.P.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Fan","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., M.A., P.A.H., M.P.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Askari","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., M.A., P.A.H., M.P.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (A.C.P., P.A.H., M.P.T.)."},{"name":"Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., M.A., P.A.H., M.P.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmund","family":"Keung","sequence":"additional","affiliation":[{"name":"San Francisco VA Medical Center, CA (E.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merritt H.","family":"Raitt","sequence":"additional","affiliation":[{"name":"Veterans Affairs Portland Health Care System, OR 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