Abstract
Oral anticoagulation (OAC) with either new oral anticoagulants (NOACs) or Vitamin-K antagonists (VKAs) is recommended by guidelines for patients with atrial fibrillation (AF) and a moderate to high risk of stroke. Based on a claims-based data set the aim of this study was to quantify the stroke-risk dependent OAC utilization profile of German AF patients and possible causes of OAC under-use. Our claims-based data set was derived from two German statutory health insurance funds for the years 2007–2010. All prevalent AF-patients in the period 2007–2009 were included. The OAC-need in 2010 was assumed whenever a CHADS2- or CHA2DS2-VASC-score was >1 and no factor that disfavored OAC use existed. Causes of OAC under-use were analyzed using multivariate logistic regression. 108,632 AF-prevalent patients met the inclusion criteria. Average age was 75.43 years, average CHA2DS2-VASc-score was 4.38. OAC should have been recommended for 56.1/62.9 % of the patients (regarding factors disfavouring VKA/NOAC use). For 38.88/39.20 % of the patient-days in 2010 we could not observe any coverage by anticoagulants. Dementia of patients (OR 2.656) and general prescription patterns of the treating physician (OR 1.633) were the most important factors increasing the risk of OAC under-use. Patients who had consulted a cardiologist had a lower risk of being under-treated with OAC (OR 0.459). OAC under-use still seems to be one of the major challenges in the real-life treatment of AF patients. Our study confirms that both patient/disease characteristics and treatment environment/general prescribing behaviour of physicians may explain the OAC under-use in AF patients.
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Conflict of interest
Matthias Pfannkuche is employed by Boehringer Ingelheim Pharma (Germany). Thomas Wilke has acted as consultant for Boehringer Ingelheim Pharma, Bayer, GSK, LEO Pharma, Novartis, and BMS, and Pharmerit International. Ulf Maywald, Andreas Fuchs and Oliver Harks work for one of the insurance funds providing the data or their data warehouse providers (AOK Plus: Maywald/Fuchs; GWQ ServicePlus AG: Harks).
Funding
The study was funded by Boehringer Ingelheim Pharma GmbH, Germany. The study design, the collection/analysis of data and the writing of the manuscript were done independently of the funding source.
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Wilke, T., Groth, A., Pfannkuche, M. et al. Real life anticoagulation treatment of patients with atrial fibrillation in Germany: extent and causes of anticoagulant under-use. J Thromb Thrombolysis 40, 97–107 (2015). https://doi.org/10.1007/s11239-014-1136-8
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DOI: https://doi.org/10.1007/s11239-014-1136-8