Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up
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]
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
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.
Australia, anticoagulation, atrial fibrillation, ischaemic stroke, primary care, reassessment