Oral anticoagulant prescription rates poor after newly diagnosed atrial fibrillation
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Key takeaways:
- Most patients with a new atrial fibrillation diagnosis do not receive an oral anticoagulant prescription.
- Odds of receiving a prescription are associated with patient sex, race and calculated bleeding risk.
Most patients with a new atrial fibrillation diagnosis and an elevated CHA2DS2-VASc score are not prescribed an oral anticoagulant with the first 6 months, contradictory to current guidelines for AF management, researchers reported.
“It is well established that increasing age and increasing HAS‐BLED scores are associated with fewer oral anticoagulant prescriptions,” Evan Manning, MD, MPP, of the internal medicine residency training program at the University of Colorado Anschutz Medical Campus, Colorado, and colleagues wrote in the study background. “Studies in the United Kingdom and among the elderly have identified increasing Charlson Comorbidity Index as negatively associated with [oral anticoagulant] prescriptions. However, the influence of specific clinical factors such as individual comorbid health conditions and concurrent prescriptions is less studied, with prior evaluations limited in geographic scope and occurring before the widespread availability of direct oral anticoagulants in more recent years.”
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In a retrospective study, Manning and colleagues analyzed electronic health records data from 18,404 patients with a new diagnosis of AF between January 2013 and December 2018 (median age, 73.9 years; 53% men). Researchers also assessed CHA2DS2-VASc scores.
The primary outcome was prescription of an oral anticoagulant during the first 6 months after AF diagnosis. In secondary analyses, researchers also assessed the odds of receiving an oral anticoagulant prescription with respect to 17 independent clinically relevant variables.
“The 6-month period was selected to provide a reasonable time frame for outpatient medication initiation and in consistency with other studies that use similar periods to define new AF ranging 90 days to 6 months,” the researchers wrote.
The findings were published in Clinical Cardiology.
Within the cohort, 41.3% of patients received an oral anticoagulant prescription after their AF diagnosis and 35.8% of all oral anticoagulant prescriptions were for direct oral anticoagulants.
Researchers found that male sex; white race (compared with Black race); stroke; obesity; congestive HF; vascular disorder; current antiplatelet, beta-blocker or calcium channel blocker prescription; and increasing CHA2DS2‐VASc score were positively associated with receiving an oral anticoagulant. Anemia, renal dysfunction, liver dysfunction, antiarrhythmic drug use and increasing HAS‐BLED score were negatively associated with oral anticoagulant prescription.
The researchers noted that the finding of no association between antiarrhythmic drugs and oral anticoagulants was “less intuitive” than other findings.
“The use of antiarrhythmic drugs would be expected to correlate with oral anticoagulant use; however, it is negatively associated in this study,” the researchers wrote. “We postulate that antiarrhythmic drugs may influence oral anticoagulant prescriptions among patients with lower CHA2DS2‐VASc scores and paroxysmal AF, particularly those who have a low arrhythmia burden. We hypothesize that the use of antiarrhythmic therapy suggests an intent to pursue a rhythm control strategy, thereby influencing some clinician decisions to discontinue or forgo anticoagulation. However, this is still contradictory to current guidelines in AF management.”
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