Implementation of oral anticoagulation treatment guidelines in patients with newly diagnosed atrial fibrillation

Abstract

Oral anticoagulants (OACs) are considered the mainstay in preventing stroke in atrial fibrillation (AF). OAC treatment remains suboptimal among AF patients, even after the introduction of direct oral anticoagulants (DOACs). We aimed to assess trends overtime and current implementation of OAC treatment guidelines in AF, using a large dataset of real world data from Israel.Methods: This is a retrospective cohort study that includes all adult members of Clalit Health Services, the largest healthcare provider in Israel, with newly diagnosed nonvalvular AF between January 2014 and December 2019 with CHA 2 DS 2 -VASc score ≥2. OAC treatment rates were calculated and multivariate regression models were used to identify predictors of OACs initiation.Results: Overall, 46 531 patients were included in the study. The 3-months cumulative OAC treatment rates increased consistently over the years: 46.9% (95% confi-

Atrial Fibrillation and Socioeconomic Inequality: risk, treatment and social consequences

“…An increased use of OAC over the years is consistent with prior studies (51,89,109). However, we also described a socioeconomic inequality in OAC initiation, which is only partly consistent with prior literature as previously summarized (10).…”

“…This explanation is partly supported by looking at studies which found similar results as our (51,112). Arbel et al included all patients with incident AF and a CHA2DS2-VASc score ≥2 and they reported that patients with a high socioeconomic class had a higher likelihood of receiving OAC with an OR of 1.19 (95% CI 1.12 to 1.26) (51). Another study, Sjölander et al, included patients with AF and with prior stroke (and consequently a high risk of stroke) and reported that patients with the highest income and highest education had a higher likelihood of receiving OAC with an OR of 1.16 (95% CI 1.04-1.30) and 1.18 (95% CI 1.04-1.35), respectively (112).…”

“…Consequently, the confounding effect of comorbidities might have biased the results towards no difference. This explanation is partly supported by looking at studies which found similar results as our (51,112). Arbel et al included all patients with incident AF and a CHA2DS2-VASc score ≥2 and they reported that patients with a high socioeconomic class had a higher likelihood of receiving OAC with an OR of 1.19 (95% CI 1.12 to 1.26) (51).…”

“…There is an abundance of studies indicating that low level of SEFs are associated with a lower risk of receiving NOAC (10,45,46). When looking at warfarin or OAC in general, however, several studies suggest no significant socioeconomic difference in treatment (10,(47)(48)(49), although some studies indicate an association between high levels of SEFs and more prescribed warfarin (50,51). However, there is lack of studies focusing on changes over time and if there is an indication of OAC initiation.…”

Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

“…In the cohort presented, adherence to AC in CHA 2 DS 2 -VASc in eligible patients presenting to UCCs trended upwards and reached 61% in the final year (Figure A3). In prior studies from Israel, AC therapy was shown to reach almost 50% in the final years of a 2014-2015 study [41] and up to 67% in the years 2018-2019 [42]. Importantly, both studies were conducted using data from a single HMO, while our study incorporates data from all the HMOs in the country.…”