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High rates of oral anticoagulation in atrial fibrillation patients observed in a large multi-specialty health system in the Northeast

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Abstract

Background

Anticoagulation is a cornerstone in atrial fibrillation (AF) management for stroke prevention. Studies showed that oral anticoagulants (OAC), previously limited to warfarin, were underused. Recently, non-vitamin K oral anticoagulants (NOACs) have seen widespread adoption, but it has not been well studied whether there has been a subsequent increase in OAC usage in AF patients.

Methods

We quantified OAC rates in AF patients in a large multispecialty health system in the Northeast United States. A total of 351,795 patients seen in the network over the preceding 18 months were reviewed.

Results

Of these patients, 8727 (2.5%) carried a diagnosis of AF, and, of the 6933 patients with a CHA2DS2-VASc score of 2 or higher, 5576 (80.4%) had an OAC listed as an active medication or had received a left atrial appendage occlusion device. Of the 6605 patients treated with an OAC, 5308 (80.4%) were treated with a NOAC and 1295 (19.6%) were prescribed warfarin. A higher percentage of patients with CHA2DS2-VASc ≥ 2 who had seen a cardiologist were treated with an OAC vs. those who had not seen a cardiologist in the prior 18 months (83.95% vs. 67.43%, p < 0.01).

Conclusions

We show dramatically increased OAC usage among patients with AF and that NOACs comprise the large majority of OACs compared with previous studies. This suggests an association between widespread adoption of NOACs and increased oral anticoagulation rates. Future directions include assessing barriers to oral anticoagulation and developing interventions to reduce disparity in OAC use between clinics.

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Authors and Affiliations

  1. St. Elizabeth’s Medical Center, Boston, MA, USA

    Roop Dutta & John Wylie

  2. Steward Medical Group, Dallas, TX, USA

    Sally Hurley, David Atkins & Joseph Weinstein

Authors
  1. Roop Dutta
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  2. Sally Hurley
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  3. David Atkins
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  4. Joseph Weinstein
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  5. John Wylie
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Correspondence to John Wylie.

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Ethics approval and consent to participate

This retrospective chart review study involving human participants was in accordance with the ethical standards of St. Elizabeth’s Medical Center Institutional Review Board (IRB) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. St. Elizabeth’s Medical Center’s IRB approved this study.

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Dutta, R., Hurley, S., Atkins, D. et al. High rates of oral anticoagulation in atrial fibrillation patients observed in a large multi-specialty health system in the Northeast. J Interv Card Electrophysiol 66, 1119–1124 (2023). https://doi.org/10.1007/s10840-022-01395-7

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  • DOI: https://doi.org/10.1007/s10840-022-01395-7

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