Advertisement

Clinical Drug Investigation

, Volume 39, Issue 4, pp 401–405 | Cite as

Uptake of Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation in a Single Clinical Commissioning Group in England Without Restrictions to Their Use

  • Kristina MedlinskieneEmail author
  • Matthew Fay
  • Duncan Petty
Short Communication

Abstract

Background and Objective

In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation has been slow and varied across different Clinical Commissioning Groups (CCGs). This study aimed to profile the prescribing of oral anticoagulants for stroke prevention in patients with atrial fibrillation over 3 years in a CCG without restrictions to DOACs use to understand more about organisational and/or individual barriers to the early uptake of DOACs.

Methods

Data were collected from nine general practices between 1 April 2012 and 31 March 2015 of patients who were initiated on the oral anticoagulant therapy. Data were analysed descriptively and with independent Student’s t test and Chi square test to explore if there was an association between type of oral anticoagulant initiated and sex, age, type of prescriber and prior aspirin use.

Results

The early uptake of DOACs significantly increased over the study period (p < 0.0001; medium size effect φc = 0.372). There was no statistically significant difference between sex or age and type of oral anticoagulant initiated. Primary-care prescribers were responsible for initiating the majority of oral anticoagulants (71%; N = 257) and driving the use of DOACs (72%, N = 71). Patients switched from aspirin to an oral anticoagulant were more likely to be initiated on warfarin than a DOAC.

Conclusions

The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers in this particular CCG.

Notes

Acknowledgements

The authors would like to thank Dr Iuri Marques, from the University of Bradford, for his advice on statistical analysis in this manuscript.

Compliance with Ethical Standards

Funding

This study was funded by Bayer Pharmaceuticals via an unrestricted educational grant. Bayer Pharmaceutical played no role in the design, conduct or analysis of this study or writing of the manuscript.

Ethical approval

Ethical approval was granted by the Chair of the Biomedical, Natural, Physical and Health Sciences Research Ethics Panel at the University of Bradford.

Informed consent

Informed consent is not required for this type of study.

Conflict of interest

Kristina Medlinskiene has received a sponsorship from Bayer to attend a conference (conference fee, accommodation and travel expenses). Matthew Fay has received funding from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, Dawn 4S, INRStar, Pfizer for travel expenses. His partnership (Westcliffe Health Innovations) has received funding from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, Dawn 4S, INRStar, Pfizer for time for presentations of consultancy and Ad boards. Duncan Petty has received honoraria for consultancy from Bayer and Pfizer.

References

  1. 1.
    Lane DA, Skjoth F, Lip GYH, LarsenTB, Kotecha D. Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care. J Am Heart Assoc. 2017;6:e005155.Google Scholar
  2. 2.
    Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1999;22:983–8.CrossRefGoogle Scholar
  3. 3.
    Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circulation Research. 2017;120:439–48.CrossRefGoogle Scholar
  4. 4.
    Saka O, McGuire A, Wolfe C. Cost of stroke in the United Kingdom. Age and Ageing. 2009;38:27–32.CrossRefGoogle Scholar
  5. 5.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37:2893–962.CrossRefGoogle Scholar
  6. 6.
    Bai Y, Guo SD, Deng H, Shantsila A, et al. Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-regression analysis. Age and Ageing. 2017;47:9–17.CrossRefGoogle Scholar
  7. 7.
    Burn J, Pirmohamed M. Direct oral anticoagulants versus warfarin: is new always better than old? Open Heart. 2015;5:e000712.CrossRefGoogle Scholar
  8. 8.
    The Association of the British Pharmaceutical Industry. One year on: Why are patients still having unnecessary AF-related strokes? 2016. http://www.abpi.org.uk/media/1404/safi_one_year_on.pdf. Accessed 23 Apr 2018.
  9. 9.
    National Institute for Health and Care Excellence. Atrial Fibrillation: management (CG180). 2014. https://www.nice.org.uk/guidance/cg180/. Accessed 5 Dec 2016.
  10. 10.
    National Institute for Health and Care Excellence. Costing report: atrial fibrillation. Implementing the NICE guideline on atrial fibrillation (CG180). 2014. https://www.nice.org.uk/guidance/cg180/resources/costing-report-243730909. Accessed 30 May 2018.
  11. 11.
    Camm AJ, Pinto FJ, Hankey GJ, Andreotti F, et al. Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation. Europace. 2015;17:1007–17.CrossRefGoogle Scholar
  12. 12.
    NHS Yorkshire and Humber Commissioning Support Group. West Yorkshire AC Clinic Provision. 2014. http://www.yhscn.nhs.uk/media/PDFs/cvd/Stroke/Documents_AF/yhscn-stroke-10ccStrokeACClinicBaseline-20150825.pdf. Accessed 30 May 2018.
  13. 13.
    Potpara TS, Pison L, Larsen TB, et al. How are patients with atrial fibrillation approached and informed about their risk profile and available therapies in Europe? Results of the European Heart Rhythm Association Survey. Europace. 2015;17:468–72.CrossRefGoogle Scholar
  14. 14.
    Loo SY, Dell’Aniello S, Huiart L, Renoux C. Trends in the prescription of novel oral anticoagulants in UK primary care. British Journal of Clinical Pharmacology. 2017;20:96–106.Google Scholar
  15. 15.
    Cowan JC, Wu J, Hall M, Orlowski A, West RM, Gale CP. A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation. Eur Heart J. 2018;0:1–9.Google Scholar
  16. 16.
  17. 17.
    Open Prescribing. Direct Oral Anticoagulants (DOACs) by all CCGs. https://openprescribing.net/measure/doacs/. Accessed 7 Aug 2018.
  18. 18.
    Pottegard A, Poulsen BK, Larsen MD, Hallas J. Dynamics of vitamin K antagonists and new oral anticoagulant use in atrial fibrillation: a Danish drug utilization study. Journal of Thrombosis and Haemostasis. 2014;12:1413–8.CrossRefGoogle Scholar
  19. 19.
    Weitz JI, Semchuk W, Turpoie AG, et al. Trends in prescribing oral anticoagulants in Canada, 2008–2014. Clinical Therapeutics. 2015;37:2506–14.CrossRefGoogle Scholar
  20. 20.
    O’Neal WT, Sandesara PB, Claxton JS, et al. Provider speciality, anticoagulation prescription patterns, and stroke risk in atrial fibrillation. J Am Heart Assoc. 2018;7:e007943.Google Scholar
  21. 21.
    Andrade JG, Krahn AD, Skanes AC, Purdham D, Ciaccia A, Conors S. Value and preferences of physicians and patients with nonvalvular atrial fibrillation who receive oral anticoagulation therapy for stroke prevention. Canadian Journal of Cardiology. 2017;32:747–53.CrossRefGoogle Scholar
  22. 22.
    Choi JC, DiBonaventura M, Kopenhafer L, Nelson WW. Survey of the use of warfarin and the newer anticoagulant dabigatran in patients with atrial fibrillation. Patient Prefer Adherence. 2014;8:167–77.Google Scholar
  23. 23.
    Borg CX, Shaw R, Lane DA. Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulation therapy: a qualitative meta-synthesis. Patient Education and Counseling. 2012;88:330–7.CrossRefGoogle Scholar
  24. 24.
    Verheugt FWA, Gao H, Mahmeed WA, Ambrosio G, Anghchaisuksiri P, Atar D, Bassand JP, Camm AJ, Cools F, Eikelboom J, Kayani G, Lim TW, Misselwitz F, Pieper KS, van Eickels M, Kakkar AF, GARFIELD-AF Investigators. Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry. Eur Heart J. 2018;39:464–73.Google Scholar
  25. 25.
    Royal College of Physicians. Sentinel Stroke National Audit Programme (SSNAP). Clinical audit April–July 2017 public report. National results. https://www.strokeaudit.org/Documents/National/Clinical/AprJul2017/AprJul2017-PublicReport.aspx. Accessed 18 March 2018.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of Pharmacy and Medical SciencesUniversity of BradfordBradfordUK
  2. 2.Medicines Management and Pharmacy ServicesLeeds Teaching Hospitals NHS TrustLeedsUK
  3. 3.The Willows Medical CentreQueensburyUK

Personalised recommendations