Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants)
D-AB26 - Refining Stroke Prevention in Atrial Fibrillation (ID 13)
Abstract
D-AB26-04 - A Population-based Study Of Temporal Trends In Adherence To Oral Anticoagulation Therapy For Newly Diagnosed Nonvalvular Atrial Fibrillation At High Risk Of Stroke (ID 804)
Abstract
Background: Adherence to oral anticoagulation (OAC) therapy is important to prevent morbidity and mortality in eligible patients with non-valvular atrial fibrillation (NVAF).
Objective: To identify trends in OAC adherence for newly diagnosed NVAF patients at high risk of stroke.
Methods: Newly diagnosed NVAF patients ≥ 18 years were identified as those having a hospitalization, emergency department, or outpatient practitioner claim with an ICD-10 code I48 between April 1 2009 and March 31 2015 in Alberta, Canada. High risk for stroke was defined by CHA2DS2-VASc score ≥ 2 in men and ≥ 3 in women. One-year direct oral anticoagulant (DOAC) adherence was based on the proportion of days covered and categorized as low (0-39%), intermediate (40-79%), and high (80-100%); time in therapeutic range (TTR) ≥65% was used to define high adherence for warfarin.
Results: Of 53,901 patients with newly diagnosed NVAF, mean age was 68 +16 years, 55% were men, and 65% were eligible to receive OAC. Overall, 58% of eligible patients were prescribed OAC; 68% warfarin versus 32% a DOAC. The time to OAC uptake was 37% at 30 days, 49% at 90 days, 54% at 180 days, and 58% at 1-year. Of the patients who received a DOAC, 11% had low, 22% had intermediate, and 66% had high adherence; 57% of patients on warfarin had a TTR ≥65%. Adherence to DOAC therapy improved over time but not for warfarin (Figure 1; p<0.0001).
Conclusion: We found over 40% of patients with newly diagnosed NVAF at high risk of stroke are not started on OAC therapy within 1-year of diagnosis. Adherence to DOAC therapy has increased over time but not to warfarin. Wider implementation of care pathways and other strategies to improve timely and appropriate OAC therapy are needed.
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Objective: To identify trends in OAC adherence for newly diagnosed NVAF patients at high risk of stroke.
Methods: Newly diagnosed NVAF patients ≥ 18 years were identified as those having a hospitalization, emergency department, or outpatient practitioner claim with an ICD-10 code I48 between April 1 2009 and March 31 2015 in Alberta, Canada. High risk for stroke was defined by CHA2DS2-VASc score ≥ 2 in men and ≥ 3 in women. One-year direct oral anticoagulant (DOAC) adherence was based on the proportion of days covered and categorized as low (0-39%), intermediate (40-79%), and high (80-100%); time in therapeutic range (TTR) ≥65% was used to define high adherence for warfarin.
Results: Of 53,901 patients with newly diagnosed NVAF, mean age was 68 +16 years, 55% were men, and 65% were eligible to receive OAC. Overall, 58% of eligible patients were prescribed OAC; 68% warfarin versus 32% a DOAC. The time to OAC uptake was 37% at 30 days, 49% at 90 days, 54% at 180 days, and 58% at 1-year. Of the patients who received a DOAC, 11% had low, 22% had intermediate, and 66% had high adherence; 57% of patients on warfarin had a TTR ≥65%. Adherence to DOAC therapy improved over time but not for warfarin (Figure 1; p<0.0001).
Conclusion: We found over 40% of patients with newly diagnosed NVAF at high risk of stroke are not started on OAC therapy within 1-year of diagnosis. Adherence to DOAC therapy has increased over time but not to warfarin. Wider implementation of care pathways and other strategies to improve timely and appropriate OAC therapy are needed.
