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Objective: To determine the use of different anticoagulation therapies in rural Western Australia; to establish whether remoteness from health care services affects the choice of anticoagulation therapy; to gather preliminary data on anticoagulation therapy safety and efficacy. Design: Retrospective cohort study of patients hospitalised with a principal diagnosis of atrial fibrillation/flutter (AF) or venous thromboembolism (VTE) during 2014–2015. Setting: Four hospitals serving two‐thirds of the rural population of Western Australia. Participants: 609 patients with an indication for anticoagulation therapy recorded in their hospital discharge summary for index admission. Main outcome measures: Prescribing rates of anticoagulation therapies by indication for anticoagulation and distance of patient residence from their hospital. The primary safety outcome was re‐hospitalisation with a major or clinically relevant non‐major bleeding event; the primary lack‐of‐efficacy outcome was re‐hospitalisation for a thromboembolic event. Results: The overall rates of prescription of NOACs and warfarin were similar (34% v 33%). A NOAC was prescribed more often than warfarin for patients with AF (56.0% v 42.2% of those who received an anticoagulant; P < 0.001), but less often for patients with VTE (29% v 48%; P < 0.001). Warfarin was prescribed for 38% of patients who lived locally, a NOAC for 31% (P = 0.013); for non‐local patients, the respective proportions were 29% and 36% (P = 0.08). 69% of patients with AF and a CHA2DS2–VASc score ≥ 1 were prescribed anticoagulation therapy. Patients treated with NOACs had fewer bleeding events than patients treated with warfarin (nine events [4%] v 20 events [10%]; P = 0.027). Conclusions: In rural WA, about one‐third of patients with an indication for anticoagulation therapy receive NOACs, but one‐third of patients with AF and at risk of stroke received no anticoagulant therapy, and may benefit from NOAC therapy.

AimsTo describe the distribution of Acute Rheumatic Fever (ARF) using deprivation and ethnicity, utilising cases in the Bay of Plenty District Health Board, New Zealand.BackgroundARF has a significant associated morbidity and mortality. Thorough understanding of epidemiological associations is important for risk assessment and intervention targeting. The Bay of Plenty (BOP) region in New Zealand (NZ) has a high rate of ARF (34/100,000) and is therefore a useful population to study this disease.MethodWe undertook a retrospective cohort study of those with a principle diagnosis of ARF from 2000–2015 using the NZNHF and Cardiac Society of ANZ criteria 2006–2014. Comparison was made between incidence, ethnicity (Maori, Pacific, European) and deprivation based on residential location (scored using the NZ Deprivation Index 2006 (NZ DEP); 1=least deprived, 10=most deprived). The eastern region (EBOP) was also compared with the western region (WBOP). Data was sourced from medical and 2013 census records.Results156 cases were identified, average age 12.6 (2–43), 72% were male (n=113). Increased deprivation was associated with increased incidence of ARF; 49% (n=76) of all cases were found in decile 10 (most deprived), and 12.2% (n=19), were in deciles 1–5. Maori ethnicity represented 90% of cases (35x increased risk compared with non-Maori). The WBOP had a lower general deprivation compared with the EBOP (WBOP=5.9, EBOP=7.3) and average ARF case deprivation reflected this (WBOP 7.0, EBOP=9.4). Further, WBOP ARF cases (n=55) showed a more spread distribution (NZ DEP 1–5; WBOP=25%, EBOP=6%). Maori ethnicity maintained a strong association with ARF cases in the WBOP despite lower deprivation (r=0.98).DiscussionARF risk was associated with increased deprivation and Maori ethnicity conferred a high risk independently to deprivation. Our results highlight to professionals working with children, including those in the UK, that although ARF is a disease strongly associated with deprivation, social risk factors may be operating irrespectively and should be considered when determining risk.

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