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Patients with paroxysmal AF may be undertreated with anticoagulants
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The number of patients with paroxysmal atrial fibrillation who are prescribed anticoagulants has increased, but this patient population is still less likely to be treated with anticoagulants than those with other types of AF, according to a study published in Heart.
“Underuse of anticoagulants in patients with paroxysmal AF is likely to result in preventable strokes among this group, leading to greater levels of avoidable death and disability,” Nicola Adderley, MA, MSci (Cantab), MA, MPhil, PhD, MPH, research fellow at the Institute of Applied Health Research at the University of Birmingham in the United Kingdom, said in a press release. “Although the gap is narrowing, we need to remind ourselves that all patients with AF are at increased risk for stroke. Paroxysmal AF patients should be given the same priority for stroke prevention as other AF patients.”
Guidelines from Europe and the United Kingdom currently recommend treating all patients with AF, regardless of pattern or duration, and a CHA2DS2-VASc score of 2 or greater with anticoagulants. Men with a CHA2DS2-VASc score of 1 may also be considered for anticoagulants, according to the guidelines.
Andrea Isaew , BSc, clinical research nurse at the University of Birmingham, and colleagues performed 16 sequential cross-sectional analyses of primary care data from more than 4 million patients from 648 practices in the United Kingdom from 2000 to 2015. From the database, 179,343 patients aged 35 years and older were diagnosed with paroxysmal AF or other types of AF, including persistent and permanent AF. There were 848,852 records of AF, as patients could have been diagnosed more than once within the study period.
The outcome of interest was treatment with anticoagulants.
The rate of patients diagnosed with paroxysmal AF increased from 7.4% (95% CI, 7-7.8) in 2000 to 14% (95% CI, 13.7-14.3) in 2015. The prevalence of patients with paroxysmal AF and a CHA2DS2-VASc score of 1 or greater who were prescribed anticoagulants increased from 18.8% (95% CI, 16.4-21.4) in 2000 to 56.2% (95% CI, 55-57.3) in 2015. The increase was also seen in patients diagnosed with other types of AF from 2000 (34.2%; 95% CI, 33.3-35) to 2015 (69.4%; 95% CI, 68.9-69.8).
Patients with paroxysmal AF were half as likely to be treated with anticoagulants than those with other types of AF in 2000 (RR = 0.48; 95% CI, 0.42-0.55), and the disparity continued into 2015 (RR = 0.76; 95% CI, 0.74-0.77). Similar results persisted after adjustment for sex, age, CHA2DS2-VASc score, Townsend score, and presence or absence of contraindications.
“The question remains as to whether the difference in treatment between patients with paroxysmal AF and patients with other AF is the result of lower levels of treatment initiation by clinicians or whether patients with paroxysmal AF are more likely to stop their treatment, and explore the reasons why,” Isaew and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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