Antithrombotic Therapy in Atrial Fibrillation Management in Western Australia: Temporal Trends and Evidence-Treatment Gaps

Hutchens, R.; Hung, Joseph; Briffa, Tom; McQuillan, Brendan

doi:10.1016/j.hlc.2020.10.026

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…Furthermore, prescription of oral anticoagulant (OAC) including the uptake of novel oral anticoagulants was not available and may influence the outcomes reported in this study. Nevertheless, global 42–44 and local 45 , 46 literature has shown that even though OAC use has increased by varying degrees (8% increase in the USA, 43 up to 20% change in Germany, 44 and 12.5% in Australia 45 ), its use remains suboptimal. 42 , 45 , 46 Whether treatments provided were adherent with guidelines recommendations for any individual patient was not captured in administrative data.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, global 42–44 and local 45 , 46 literature has shown that even though OAC use has increased by varying degrees (8% increase in the USA, 43 up to 20% change in Germany, 44 and 12.5% in Australia 45 ), its use remains suboptimal. 42 , 45 , 46 Whether treatments provided were adherent with guidelines recommendations for any individual patient was not captured in administrative data. Thus, the effect of appropriateness of treatment decisions on outcomes could not be evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes after hospitalization for atrial fibrillation or flutter

Ngo,

Peng,

Denman

et al. 2024

European Heart Journal

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Background and Aims Atrial fibrillation (AF) and flutter are common causes of hospitalizations but contemporary long-term outcomes following these episodes are uncertain. This study assessed outcomes up to 10 years after an acute AF or flutter hospitalization. Methods Patients hospitalized acutely with a primary diagnosis of AF or flutter from 2008–17 from all public and most private hospitals in Australia and New Zealand were included. Kaplan–Meier methods and flexible parametric survival modelling were used to estimate survival and loss in life expectancy, respectively. Competing risk model accounting for death was used when estimating incidence of non-fatal outcomes. Results A total of 260 492 adults (mean age 70.5 ± 14.4 years, 49.6% female) were followed up for 1 068 009 person-years (PY), during which 69 167 died (incidence rate 6.5/100 PY) with 91.2% survival at 1 year, 72.7% at 5 years, and 55.2% at 10 years. Estimated loss in life expectancy was 2.6 years, or 16.8% of expected life expectancy. Re-hospitalizations for heart failure (2.9/100 PY), stroke (1.7/100 PY), and myocardial infarction (1.1/100 PY) were common with respective cumulative incidences of 16.8%, 11.0%, and 7.1% by 10 years. Re-hospitalization for AF or flutter occurred in 21.3% by 1 year, 35.3% by 5 years, and 41.2% by 10 years (11.6/100 PY). The cumulative incidence of patients undergoing catheter ablation of AF was 6.5% at 10 years (1.2/100 PY). Conclusions Patients hospitalized for AF or flutter had high death rates with an average 2.6-year loss in life expectancy. Moreover, re-hospitalizations for AF or flutter and related outcomes such as heart failure and stroke were common with catheter ablation used infrequently for treatment, which warrant further actions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term outcomes after hospitalization for atrial fibrillation or flutter

Ngo,

Peng,

Denman

et al. 2024

European Heart Journal

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“…Despite guidelines recommending initiation of anticoagulant therapy in high-risk patients with AF [ 11 ], approximately 33% to 50% of patients in the United States do not receive anticoagulant treatment after their diagnosis [ 14 , 15 ]. Studies from Denmark [ 27 ], Western Australia [ 28 ], and 2 global registries [ 29 , 30 ] also demonstrated the underuse of anticoagulants in patients with AF, suggesting that this trend extends outside the United States. Our results add to the current evidence-based literature regarding anticoagulants being underused among patients with AF and highlight the need for strategies to increase anticoagulant initiation, particularly in primary care settings, where most of these patients seem to be diagnosed and managed.…”

Section: Discussionmentioning

confidence: 99%

“…initiation of anticoagulant therapy in high-risk patients with AF [11], approximately 33% to 50% of patients in the United States do not receive anticoagulant treatment after their diagnosis [14,15]. Studies from Denmark [27], Western Australia [28], and 2 global registries [29,30] also demonstrated the underuse of anticoagulants in patients with AF, suggesting that this trend extends outside the United States. Our results add to the current evidence-based…”

Section: Plos Onementioning

confidence: 99%

Associations between clinical and social factors and anticoagulant prescription among patients with atrial fibrillation: A retrospective cohort study from a large healthcare system

Khatib¹,

Glowacki²,

Colavecchia

et al. 2023

PLoS ONE

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Background Patient clinical factors and social determinants of health (SDOH) are associated with an increased risk of stroke for patients with atrial fibrillation (AF); however, the association between these factors and the management of AF is not well characterized, particularly among those factors commonly collected in electronic health records (EHRs). This study used EHR data to evaluate the associations between patient clinical factors and SDOH and prescribing of an oral anticoagulant (OAC) for stroke prevention in AF. Methods This analysis included adult patients with newly diagnosed AF who had ≥2 encounters in the Advocate Aurora Health system in Wisconsin between May 2016 and May 2021. Patient-level demographics, comorbidities, medications, and SDOH were retrospectively extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status. Results Of 16,656 patients with AF, 10,898 (65.4%) were prescribed an OAC within the first year of diagnosis. Patients were less likely to be prescribed an OAC (relative risk [95% CI]) if they were widowed (0.98 [0.96–0.99] vs single) or had a history of alcoholism (0.86 [0.79–0.95] vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased prescriptions for warfarin vs those for direct-acting OACs. Conclusions Although guideline-concordant anticoagulant use remained suboptimal, clinical characteristics were strongly associated for whether a patient with AF would be prescribed an OAC. Disparities in patient care regarding the prescribing of OACs due to SDOH and associated behaviors were small but present, particularly for national ADI.

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“…Although the OAC therapy rate was similar with previously reported 4.1% in general population, 27 it remained significantly lower than the rate reported in developing countries ranging from 50% to 71%. 28 Therefore, long‐term education and management of AF among hypertensive population in northeast China should be highlighted.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of atrial fibrillation and the risk of cardiovascular mortality among hypertensive elderly population in northeast China

Xia

Wei

Yang

et al. 2022

J of Clinical Hypertension

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Little is known about the epidemiology and impact of atrial fibrillation (AF) on cardiovascular diseases (CVD) mortality among hypertensive elderly population in northeast China. The community-based study included 4497 hypertensive elderly residents aged ≥65 years who lived in northeast China from September 2017 to March 2019.Information on CVD deaths was obtained from baseline until July 31, 2021. Cox proportional hazard regression models were performed in the evaluation of CVD mortality. We identified 101 persons with AF. The prevalence of AF was 2.2% among elderly hypertensive population, which increased significantly with age. The prevalence of AF was higher in men than in women. The awareness rate was 51.5%, higher in urban areas than in rural areas (68.8% vs 43.5%, P = .018). Only 4.0% patients received oral anticoagulant (OAC) therapy among AF patients. Moreover, diabetes (26.7%) and dyslipidemia (37.6%) were highly prevalent in AF patients. Furthermore, 212 persons died due to CVD (14.7/1000 person-years) during a median follow-up of 3.2 years. AF patients had a 3.42 (95% CI: 2.07-5.63) times higher risk of CVD mortality than the patients without AF in the fully adjusted model. Therefore, the burden of AF among hypertensive elderly population in northeast China was considerable. Longterm screening and management strategies for AF and related risk factors are required among hypertensive elderly in northeast China.

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Antithrombotic Therapy in Atrial Fibrillation Management in Western Australia: Temporal Trends and Evidence-Treatment Gaps

Cited by 7 publications

References 23 publications

Long-term outcomes after hospitalization for atrial fibrillation or flutter

Long-term outcomes after hospitalization for atrial fibrillation or flutter

Associations between clinical and social factors and anticoagulant prescription among patients with atrial fibrillation: A retrospective cohort study from a large healthcare system

Prevalence of atrial fibrillation and the risk of cardiovascular mortality among hypertensive elderly population in northeast China

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