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Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Direct oral anticoagulants (DOACs) are widely marketed as medicines that do not require routine laboratory monitoring. However, they do have complex pharmacological properties and side effects; hence prescribing and monitoring guidelines, such as the European Heart Rhythm Association (EHRA) guidelines, have emerged. These advocate monitoring for renal and hepatic impairment; bleeding episodes; liver function; co-medication; circulation, and occurrence of side effects. Though 3 to 6 month follow-up is advocated, this is currently not routine, and its implementation creates a potential obligation for general practitioners (GPs) managing atrial fibrillation (AF) patients in the community.

Aims

This study investigates the frequency, the type of follow-up, and the factors that influenced follow-up among Irish GPs, who prescribed DOACs to patients with AF, to prevent strokes in 2015.

Methods

The frequency and type of follow-up care is estimated, and a count model regression analysis is applied to determine the GP and practice characteristics that are associated with the implementation of follow-up.

Results

The EHRA guidelines most frequently followed were those pertaining to renal function (82%), bleeding episodes (71%), liver function (69%), circulation (54%), and side effects (55%). The regression analysis revealed that female GPs (P = 0.05) and GPs who follow all seven guidelines (P = 0.06) practice more frequent follow-up while those in training practices (P = 0.09) provide less frequent follow-up.

Conclusions

Results show that there was incomplete adherence to the 2013 EHRA prescribing guidelines with only 24% adhering to all seven guidelines, and patient follow-up was less frequent than has been suggested.

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Availability of data and materials

The raw data supporting this study are publicly available.

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Acknowledgments

We are grateful to all General Practitioners who participated in the study.

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Authors and Affiliations

  1. Department of Economics, Cork University Business School, University College Cork, Aras na Laoi, Western Rd., Cork, Ireland

    Aileen Murphy & Ann Kirby

  2. Department of General Practice, School of Medicine, Western Gateway Building, University College Cork, Cork, Ireland

    Colin Bradley

Authors
  1. Aileen Murphy
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  2. Ann Kirby
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  3. Colin Bradley
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Contributions

AM and AK had primary responsibility for analysis and interpretation of the data. All authors contributed to the conception and planning of the work and drafting the manuscript.

Corresponding author

Correspondence to Aileen Murphy.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was acquired from University’s Social Research Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Murphy, A., Kirby, A. & Bradley, C. Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention. Ir J Med Sci 189, 961–966 (2020). https://doi.org/10.1007/s11845-019-02150-0

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  • DOI: https://doi.org/10.1007/s11845-019-02150-0

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