Factors associated with oral anticoagulant prescription status among patients with a new diagnosis of atrial fibrillation

Abstract

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in adults and increases stroke risk. Treatment with oral anticoagulants (OACs) may reduce this risk however many patients do not receive OAC therapy. This study aimed to use electronic health record data to identify newly diagnosed AF patients at high risk for stroke and not anticoagulated as well as factors associated with OAC prescription.HypothesisTimely prescription of OACs among patients with newly diagnosed AF is poor.MethodsWe performed a retrospective study of patients with a new diagnosis of AF. We assessed stroke risk with the CHA2DS2‐VASc score. The primary outcome was prescription of an OAC within 6 months following diagnosis. We used logistic regression to see how the odds of being prescribed an OAC differs for 17 independent variables.ResultsWe identified 18 404 patients with a new diagnosis of AF. Among patients at high risk for stroke, 41.3% received an OAC prescription within 6 months. Male sex, Caucasian compared to African American race, stroke, obesity, congestive heart failure, vascular disorder, current antiplatelet, beta blocker, or calcium channel blocker prescription, and increasing CHA2DS2‐VASc score were positively associated with receiving an OAC. Whereas anemia, renal dysfunction, liver dysfunction, antiarrhythmic drug use and increasing HAS‐BLED score were negatively associated.ConclusionsMost newly diagnosed AF patients at high stroke risk do not receive an OAC prescription in the first 6 months following diagnosis. Our analysis suggests that patient sex, race, comorbidities, and additional prescriptions are associated with rates of OAC prescribing.

Factors associated with prescription of oral anticoagulants in the era of direct oral anticoagulants

“…3 In the authors' study, the use of antiarrhythmic drugs was associated with a lower rate of OAC prescription, which is inconsistent with other previous studies. 1 This is probably due to the old concept: rhythm control versus rate control, in which rhythm control is sufficient to prevent stroke without anticoagulation. 2 Again, the observation period may be relatively too old to apply their findings to the current era.…”

“…Appropriate prescription of oral anticoagulants (OACs) for patients with atrial fibrillation (AF) and high stroke risk is of great importance. Manning 1 and colleagues evaluated the prevalence of OAC prescription within 6 months after the first diagnosis of AF in patients at high stroke risk during the observation period between 2013 and 2018. 1 They demonstrated that most newly diagnosed AF patients at high stroke risk did not receive OAC prescription within the first 6 months after the diagnosis.…”

“…Manning 1 and colleagues evaluated the prevalence of OAC prescription within 6 months after the first diagnosis of AF in patients at high stroke risk during the observation period between 2013 and 2018. 1 They demonstrated that most newly diagnosed AF patients at high stroke risk did not receive OAC prescription within the first 6 months after the diagnosis. Several parameters were associated with the prescription/nonprescription of OACs.…”

“…The total prescription rate of OACs, as well as that of direct OACs (DOACs), increased yearly during the observation period. 1 Now is the era of DOAC, 2 and it may be ideal to start the study period from the time when DOAC came in the market. Could the authors explain the reason why they defined the study period between 2013 and 2018?…”