The use status of anticoagulation drugs for inpatients with nonvalvular atrial fibrillation in Southwest China

Abstract

Background Oral anticoagulants (OACs) are effective for the prophylaxis of stroke in patients with atrial fibrillation (AF). This cross-sectional study aimed to investigate the status of anticoagulation treatment for hospitalized AF patients in Southwest China. Methods A total of 4760 hospitalized patients with AF were enrolled from 21 hospitals in Chongqing city from January 1 to December 31, 2013. Results Among the enrolled patients, 3785 were diagnosed with nonvalvular AF. These patients had a mean age of 74.4±10.1 years. The mean CHADS 2 score of all subjects was 2.60±1.34, and 80.7% of the patients had CHADS 2 ≥2. The use rate of OACs was only 11.5% for patients with a high risk for stroke (CHADS 2 ≥2) and was much lower in patients from the second-level hospitals than in patients from the third-level hospitals (5.8% vs. 16.9%, P <0.001). The leading reason for the underuse of OACs in high-risk patients was physician’s nonfeasance. Conclusion This study demonstrated that the underuse of anticoagulation therapy in hospitalized patients with nonvalvular AF was particularly serious in Southwest China, especially in the second-level hospitals. Urgent and effective measures are desperately needed to improve this alarming situation in China.

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

“…Similar data have been observed in various studies in Spain, Europe, North America and Japan . A recent study in southern China reported a use of OA of only 11.5% …”

“…15 A recent study in southern China reported a use of OA of only 11.5%. 16 The reasons for the underprescription of OA have been studied. In a systematic review of 30 studies, the factors that influenced the non-prescription of OA in patients with NVAF were advanced age, risk of bleeding, prior bleeding, risk of falls, comorbidities and the ability to comply with the treatment.…”

Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study

“…Consistent with other studies, providers were reluctant to prescribe OACs based on age, perceived frailty, and past history of falls, 33,36 despite a lack of evidence that these characteristics identify patients less likely to benefit from OACs. Data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry found that 13% of patients had a contraindication to warfarin documented at the baseline visit, and two of the four most common contraindication reasons included high risk for bleeding (18%) and frequent falls (18%).…”

The use of anticoagulants in patients with non-valvular atrial fibrillation between 2005 and 2014: A drug utilization study using claims data in Japan

“…Indeed, our study confirmed the underuse of the anticoagulant in patients with NVAF repeatedly observed and reported worldwide [2–15]. However, this proportion (38.4% to 58.0%) of patients had the diagnosis code of NVAF.…”

“…According to estimates based on periodical health examinations in Japan, 0.56% of the population (approximately 700,000 persons) had AF in 2005 [ 1 ]. Despite anticoagulant therapy being recommended for the prevention of stroke and systemic embolism, it remains underused for patients with AF [ 2 – 15 ]. The main reasons for the underuse of anticoagulants include concerns about the risk of major bleeding associated with anticoagulant therapy and the need for frequent coagulation monitoring to maintain the target international normalized ratio (INR) inherent in warfarin therapy.…”