Temporal Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients between 2004 and 2019
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Study Population
2.2. Covariaties
2.3. Stroke Risk Assessment
2.4. Antithrombotic Therapy among the Study Group
2.5. Statistical Analyses
3. Results
3.1. Patient Characteristics
3.2. Temporal Trends in Antithrombotic Therapy between 2004 and 2019 in the Total Study Population
3.3. Temporal Trends in Antithrombotic Therapy between 2004 and 2019 in High Stroke Risk Patients
3.4. Temporal Trends in Antithrombotic Therapy between 2004 and 2019 in Intermediate Stroke Risk Patients
3.5. Temporal Trends in Antithrombotic Therapy between 2004 and 2019 in Low Stroke Risk Patients
3.6. Factors Associated with OAC Use in the Total Study Population
4. Discussion
5. Study Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Clinical Characteristic | All n = 9656 | OAC Therapy n = 7827 | No OAC Therapy n = 1829 | APT Therapy n = 1307 | Heparin Therapy n = 199 | No Therapy n = 323 |
---|---|---|---|---|---|---|
Type of Atrial Fibrillation | ||||||
Paroxysmal | 4389 (45.5) | 3269 (41.8) | 1120 (61.2) | 825 (63.1) | 95 (47.7) | 200 (61.9) |
Persistent | 1439 (14.9) | 1343 (17.2) | 96 (5.3) | 59 (4.5) | 13 (6.5) | 24 (7.4) |
Permanent | 3828 (39.6) | 3215 (41.1) | 613 (33.5) | 423 (32.4) | 91 (45.7) | 99 (30.7) |
Stroke risk factors | ||||||
Age, years | ||||||
Mean (SD) | 71.2 (11.2) | 71.2 (10.9) | 71.3 (12.4) | 71.8 (11.4) | 72.3 (11.6) | 68.4 (16.0) |
Median (IQR) | 72 (64–80) | 72 (64–79) | 73 (63–81) | 74 (64–80) | 75 (64.5–80.5) | 71 (60–81) |
<65 | 2501 (25.9) | 1984 (25.3) | 517 (28.3) | 349 (26.7) | 50 (25.1) | 118 (36.5) |
65–74 | 3055 (31.6) | 2593 (33.1) | 462 (25.3) | 343 (26.2) | 45 (22.6) | 74 (22.9) |
≥75 | 4100 (42.5) | 3250 (41.5) | 850 (46.5) | 615 (47.1) | 104 (52.3) | 131 (40.6) |
Female | 4221 (43.7) | 3419 (43.7) | 802 (43.9) | 571 (43.7) | 86 (43.2) | 145 (44.9) |
Heart failure | 5667 (58.7) | 4613 (58.9) | 1054 (57.6) | 731 (55.9) | 135 (67.8) | 188 (58.2) |
Hypertension | 7387 (76.5) | 6085 (77.7) | 1302 (71.2) | 962 (73.6) | 139 (69.8) | 201 (62.2) |
Previous stroke/ TIA/peripheral embolism | 1266 (13.1) | 1072 (13.7) | 194 (10.6) | 134 (10.3) | 36 (18.1) | 24 (7.4) |
Diabetes mellitus | 2463 (25.5) | 2061 (26.3) | 402 (22.0) | 293 (22.4) | 49 (24.6) | 60 (18.6) |
Vascular disease | 3364 (34.8) | 2660 (34) | 704 (38.5) | 555 (42.5) | 73 (36.7) | 76 (23.5) |
Medical history | ||||||
Bleeding | 267 (1.9) | 188 (2.4) | 79 (4.3) | 42 (3.2) | 14 (7) | 23 (7.1) |
Cancer | 408 (4.2) | 293 (3.7) | 115 (6.3) | 60 (4.6) | 36 (18.1) | 19 (5.9) |
Peptic ulcer disease | 326 (3.4) | 243 (3.1) | 83 (4.5) | 57 (4.4) | 6 (3) | 20 (6.2) |
Anemia | 1629 (16.9) | 1267 (16.2) | 362 (19.8) | 214 (16.4) | 64 (32.2) | 84 (26) |
Thrombocytopenia | 1457 (15.1) | 1158 (14.8) | 299 (16.3) | 196 (15) | 42 (21.1) | 61 (18.9) |
eGFR < 60 mL/min/1.73 m2 | 6043 (62.6) | 4925 (62.9) | 1118 (61.1) | 807 (61.7) | 120 (60.3) | 191 (59.1) |
eGFR, mean (SD) | 55.2 | 55.1 | 55.3 | 55.8 | 54.4 | 55.1 |
NSAID use | 73 (0.8) | 45 (0.6) | 14 (0.8) | 11 (0.8) | 1 (0.5) | 2 (0.6) |
Abnormal liver function | 112 (1.2) | 66 (0.8) | 23 (1.3) | 8 (0.6) | 7 (3.5) | 8 (2.5) |
Alcohol abuse | 178 (1.8) | 104 (1.3) | 37 (2.0) | 26 (1.9) | 2 (1.0) | 9 (2.8) |
Thromboembolism risk | ||||||
CHADS2 | ||||||
Mean (SD) | 2.3 (1.3) | 2.3 (1.3) | 2.2 (1.3) | 2.2 (1.3) | 2.5 (1.5) | 1.9 (1.4) |
Median (IQR) | 2 (1–3) | 2 (1–3) | 2 (1–3) | 2 (1–3) | 2 (1.5–3) | 2 (1–3) |
CHA2DS2VASc | ||||||
Mean (SD) | 3.8 (1.8) | 3.8 (1.8) | 3.7 (1.9) | 3.8 (1.8) | 4.1 (1.9) | 3.3 (2.0) |
Median (IQR) | 4 (3–5) | 4 (3–5) | 4 (2–5) | 4 (2–5) | 4 (3–5) | 4 (2–5) |
CHA2DS2VASc = 0 in men, 1 in women | 368 (3.8) | 261 (3.3) | 107 (5.9) | 48 (3.7) | 11 (5.5) | 48 (14.9) |
CHA2DS2VASc = 1 in men, 2 in women | 1024 (10.6) | 826 (10.6) | 198 (10.8) | 141 (10.8) | 14 (7) | 43 (13.3) |
CHA2DS2VASc ≥ 2 in men, 3 in women | 8264 (85.6) | 6740 (86.1) | 1524 (83.3) | 1118 (85.5) | 174 (87.4) | 232 (71.8) |
Bleeding risk | ||||||
HAS-BLED | ||||||
Mean (SD) | 1.8 (0.9) | 1.8 (0.9) | 1.6 (0.9) | 1.6 (0.9) | 2 (1.0) | 1.6 (1.1) |
Median (IQR) | 2 (1–2) | 2 (1–2) | 2 (1–2) | 2 (1–2) | 2 (1–2) | 2 (1–2) |
HAS-BLED ≥ 3 | 1676 (17.4) | 1451 (18.5)) | 227 (12.4) | 121 (9.3) | 47 (23.6) | 59 (18.3) |
Reason for hospitalization | ||||||
CIED implantation/ reimplantation | 2207 (22.9) | 1708 (21.8) | 499 (27.3) | 378 (28.9) | 47 (23.6) | 74 (22.9) |
Heart failure | 1998 (20.7) | 1707 (21.8) | 291 (15.9) | 174 (13.3) | 49 (24.6) | 68 (21.1) |
Acute coronary syndrome/planned PCI | 1213 (12.6) | 700 (8.9) | 513 (28.1) | 468 (35.8) | 17 (8.5) | 28 (8.7) |
AF without any procedures | 1122 (11.6) | 940 (12) | 182 (9.9) | 97 (7.4) | 21 (10.6) | 64 (19.8) |
Electrical cardioversion | 1056 (10.9) | 997 (12.7) | 59 (3.2) | 31 (2.4) | 11 (5.5) | 17 (5.3) |
Ablation | 339 (3.5) | 308 (3.9) | 31 (1.7) | 17 (1.3) | 2 (1.0) | 12 (3.7) |
Other | 1721 (17.8) | 1467 (18.7) | 254 (13.9) | 142 (10.9) | 52 (26.1) | 60 (18.6) |
Years of hospitalization | ||||||
2004–2006 | 1405 (14.6) | 867 (11.1) | 538 (29.4) | 432 (33.1) | 36 (18.1) | 70 (21.7) |
2007–2010 | 1663 (17.2) | 1037 (13.2) | 626 (34.2) | 549 (42) | 26 (13.1) | 51 (15.8) |
2011–2012 | 1031 (10.7) | 810 (10.3) | 221 (12.1) | 158 (12.1) | 25 (12.6) | 38 (11.8) |
2013–2016 | 2697 (27.9) | 2397 (30.6) | 300 (16.4) | 113 (8.6) | 61 (30.7) | 126 (39.0) |
2017–2019 | 2860 (29.6) | 2716 (34.7) | 144 (7.9) | 55 (4.2) | 51 (25.6) | 38 (11.8) |
Stroke Prevention | All n = 9656 | High Stroke Risk n = 8264 | Intermediate Stroke Risk n = 1024 | Low Stroke Risk n = 368 | p |
---|---|---|---|---|---|
OAC | 7827 (81.1) | 6740 (81.6) | 826 (80.7) | 261 (70.9) | <0.0001 |
VKA | 4637 (48) | 3996 (48.4) | 486 (47.5) | 48 (13) | <0.0001 |
NOAC | 3190 (33) | 2744 (33.2) | 340 (33.2) | 155 (42.1) | 0.0018 |
APT | 1307 (13.5) | 1118 (13.5) | 141 (13.8) | 106 (28.8) | <0.0001 |
Heparin | 199 (2.1) | 174 (2.1) | 14 (1.4) | 11 (3) | 0.1291 |
None | 323 (3.3) | 232 (2.8) | 43 (4.2) | 48 (13) | <0.0001 |
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Gorczyca-Głowacka, I.; Bielecka, B.; Wałek, P.; Chrapek, M.; Ciba-Stemplewska, A.; Jelonek, O.; Kot, A.; Czyżyk, A.; Pióro, M.; Major, A.; et al. Temporal Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients between 2004 and 2019. Int. J. Environ. Res. Public Health 2022, 19, 5584. https://doi.org/10.3390/ijerph19095584
Gorczyca-Głowacka I, Bielecka B, Wałek P, Chrapek M, Ciba-Stemplewska A, Jelonek O, Kot A, Czyżyk A, Pióro M, Major A, et al. Temporal Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients between 2004 and 2019. International Journal of Environmental Research and Public Health. 2022; 19(9):5584. https://doi.org/10.3390/ijerph19095584
Chicago/Turabian StyleGorczyca-Głowacka, Iwona, Bernadetta Bielecka, Paweł Wałek, Magdalena Chrapek, Agnieszka Ciba-Stemplewska, Olga Jelonek, Anna Kot, Anna Czyżyk, Maciej Pióro, Agnieszka Major, and et al. 2022. "Temporal Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients between 2004 and 2019" International Journal of Environmental Research and Public Health 19, no. 9: 5584. https://doi.org/10.3390/ijerph19095584