Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Curtain, C and Salahudeen, MS and Peterson, GM, Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation, European Journal of Clinical Investigation, 51, (5) Article e13457. ISSN 0014-2972 (2020) [Refereed Article]
Copyright 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd
Background: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF.
Methods: Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice.
Results: A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two-thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 (P < .001). High risk of stroke (CHA2DS2-VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99-4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72- 2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65-1.98]) and male sex (AOR, 1.29 [95% CI, 1.22-1.35]) were independently associated with OAC initiation. Direct-acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 (P < .001).
Conclusions: The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and individuals with dementia.
|Item Type:||Refereed Article|
|Keywords:||atrial fibrillation, oral anticoagulant, oral anticoagulant choice, oral anticoagulant initiation, primary care|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Pharmacology and pharmaceutical sciences|
|Research Field:||Clinical pharmacy and pharmacy practice|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health and support services not elsewhere classified|
|UTAS Author:||Bezabhe, WM (Dr Woldesellassie Bezabhe)|
|UTAS Author:||Bereznicki, LR (Professor Luke Bereznicki)|
|UTAS Author:||Radford, J (Professor Jan Radford)|
|UTAS Author:||Wimmer, BC (Dr Barbara Wimmer)|
|UTAS Author:||Curtain, C (Mr Colin Curtain)|
|UTAS Author:||Salahudeen, MS (Dr Mohammed Salahudeen)|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
|Web of Science® Times Cited:||11|
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