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
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.
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.
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.
The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers in this particular CCG.
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
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 was granted by the Chair of the Biomedical, Natural, Physical and Health Sciences Research Ethics Panel at the University of Bradford.
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.
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