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Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up

Citation

Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Salahudeen, MS and Garrahy, E and Bindoff, I and Peterson, GM, Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up, European Journal of Clinical Investigation Article e13489. ISSN 0014-2972 (2021) [Refereed Article]

Copyright Statement

Copyright 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd

DOI: doi:10.1111/eci.13489

Abstract

Aim: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight.

Methods: A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018.

Results: At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA2DS2-VASc (CHA2DS2-VA) score. Overall, the CHA2DS2-VA score increased by a mean of 1.34 (95% confidence interval, 1.29-1.39) points over the study period. Nearly two-thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years.

Conclusions: Nearly one-third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.

Item Details

Item Type:Refereed Article
Keywords:Australia, anticoagulation, atrial fibrillation, ischaemic stroke, primary care, reassessment
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Primary care
UTAS Author:Bezabhe, WM (Dr Woldesellassie Bezabhe)
UTAS Author:Bereznicki, LR (Professor Luke Bereznicki)
UTAS Author:Radford, J (Associate Professor Jan Radford)
UTAS Author:Wimmer, BC (Dr Barbara Wimmer)
UTAS Author:Salahudeen, MS (Dr Mohammed Salahudeen)
UTAS Author:Garrahy, E (Dr Edward Garrahy)
UTAS Author:Bindoff, I (Dr Ivan Bindoff)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
ID Code:142607
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Pharmacy
Deposited On:2021-02-01
Last Modified:2021-06-21
Downloads:0

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