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Anticoagulant use in patients with nonvalvular atrial fibrillation: has prescribing improved?

Citation

Bista, D and Chalmers, L and Peterson, GM and Bereznicki, LRE, Anticoagulant use in patients with nonvalvular atrial fibrillation: has prescribing improved?, Clinical and Applied Thrombosis/Hemostasis, 23, (6) pp. 573-578. ISSN 1076-0296 (2017) [Refereed Article]

Copyright Statement

Copyright 2016 The Authors

DOI: doi:10.1177/1076029616642511

Abstract

Discordance between international guideline recommendations and anticoagulant prescribing patterns among patients with nonvalvular atrial fibrillation (NVAF) has been frequently reported. This study was designed to compare the anticoagulant utilization pattern to earlier data in the same population and identify predictors of anticoagulant prescribing among patients with NVAF. We reviewed patients with NVAF admitted to Tasmania’s 3 major hospitals between January 2011 and June 2012 and compared the anticoagulant utilization pattern to earlier data. Patients were excluded if they had only 1 episode of NVAF that reverted spontaneously or upon cardioversion. Multivariate logistic regression analysis was used to identify predictors of anticoagulant prescribing. Overall, 53.8% of patients received anticoagulant treatment compared to 40.4% 15 years ago. Among eligible patients at high-risk of stroke, 52.5% were receiving anticoagulant therapy (vs 42.1% 15 years ago). Approximately 10% of patients with a CHADS2 score ≥ 2 were not receiving any antithrombotic treatment, reduced from 18.2% in the earlier cohort, whereas anticoagulant use increased among those at low risk (score 0) to 48.5% from 14.2%. Younger age (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.97-1.0; P = 0.04); CHADS2 = 1, relative to 0 (OR 1.68, 95% CI 1.07-2.63; P = 0.02); CHF (OR 1.56, 95% CI 1.12-2.15; P = 0.008); and embolic disease history (OR 1.77, 95% CI 1.09-2.86; P = 0.02) were significant predictors of anticoagulant prescribing. While there has been improvement over the past 15 years, suboptimal use of anticoagulant therapy among high-risk patients with NVAF remains common. There is significant potential for improvement in the quality of stroke prophylaxis in patients with NVAF.

Item Details

Item Type:Refereed Article
Keywords:anticoagulation, atrial fibrillation, anticoagulants, stroke, cardiac failure, embolism
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacy and Pharmacy Practice
Objective Division:Health
Objective Group:Other Health
Objective Field:Health not elsewhere classified
Author:Bista, D (Ms Durga Bista)
Author:Chalmers, L (Dr Leanne Chalmers)
Author:Peterson, GM (Professor Gregory Peterson)
Author:Bereznicki, LRE (Associate Professor Luke Bereznicki)
ID Code:108225
Year Published:2017 (online first 2016)
Web of Science® Times Cited:3
Deposited By:Pharmacy
Deposited On:2016-04-13
Last Modified:2017-12-08
Downloads:0

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