Atrial fibrillation: trends in prevalence and antithrombotic prescriptions in the community

Abstract

Introduction In the past decade, the atrial fibrillation (AF) landscape, including the treatment modalities, has drastically changed. This raises the question how AF prevalence and choices in antithrombotic therapy prescription have developed in the community over time. Methods Routine care data from the Julius General Practitioners’ Network (JGPN) were used to calculate the yearly prevalence of AF and to quantify the percentage of all patients who were prescribed a platelet inhibitor, vitamin K antagonist (VKA), non-VKA oral anticoagulant (NOAC) or no antithrombotic medication. To explore whether certain patient characteristics are associated with selective prescription of oral anticoagulants (OAC), we applied logistic regression analyses. Results From 2008 through 2017, the JGPN database included 7459 unique AF patients. During this period, the prevalence of AF increased from 0.4% to 1.4%. The percentage of patients prescribed a VKA declined from 47% to 41%, whereas the percentage of patients prescribed a NOAC rose from 0% to 20%. In patients with new-onset AF, older age, heart failure, diabetes mellitus, vascular disease and dementia were independently associated with a higher likelihood of VKA rather than NOAC prescription. In 2017, 25% of all patients with AF and a CHA2DS2-VASc score ≥ 2 were not prescribed OAC therapy (i.e. 8% with platelet inhibitor monotherapy and 17% without any antithrombotic therapy). Conclusion Between 2008 and 2017, AF prevalence in the community more than tripled. Prescription patterns showed possible ‘channelling’ of VKAs over NOACs in frailer, elderly patients, whereas still about one in every four AF patients with a CHA2DS2-VASc score ≥ 2 was not prescribed any prophylactic OAC therapy.

Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands

“…Furthermore, in the Netherlands, most patients with AF first seen by general practitioners are referred to a specialist, 60 and there is no reason to assume a specialist’s anticoagulation strategy would differ greatly between outpatients and inpatients. Additionally, the patient characteristics and anticoagulant use reported by a recent Dutch study 37 in community settings are very similar to ours. Third, we only investigated anticoagulation treatment and clinical outcomes within 1 year after incident AF diagnosis, and thus the trends in a longer period remain underreported.…”

“…It should be noted that this crude proportion might be overestimated, as data on medications prescribed during hospitalizations were unavailable in our study. Still, several other studies reported a comparable proportion of patients with AF who had an indication to receive OAC but did not do so . Studies with more granular data are suggested to investigate whether anticoagulation treatment is actually appropriate for these patients.…”

“…Still, several other studies reported a comparable proportion of patients with AF who had an indication to receive OAC but did not do so. 36 , 37 Studies with more granular data are suggested to investigate whether anticoagulation treatment is actually appropriate for these patients.…”

Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial

“…2 However, there is a large population of older patients with AF who are (still) taking VKAs; ≈30% to 40% of all patients with AF. 3,4 Many of these patients have the frailty syndrome, a clinical entity of accumulating comorbidities and polypharmacy, defined by a high biological vulnerability, dependency on significant others, and a reduced capacity to resist stressors. [5][6][7] These patients with AF living with frailty, currently receiving VKA treatment, are managed mainly in an outpatient setting, close to the communities where they live, by family medicine specialists, cardiologists, or internists.…”