Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019–February 2021)

Aims: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD) after recent (2019)(2020) updates to European guidelines. We aimed to describe prescription trends of low-dose rivaroxaban in ASCVD patients over the period 2015-2022 in two European countries, to compare the trends before and after guideline changes, and to determine the characteristics of users. Methods: In a cross-sectional interrupted time series analysis, utilization of low-dose rivaroxaban (2.5 mg, twice daily) was measured in Clinical Practice Research Datalink Aurum (United Kingdom [UK]) and the PHARMO Database Network (the Netherlands) from 1 January 2015 to 28 February 2022 in patients with an ASCVD diagnosis. Incidence rates (IRs) and incidence rate ratios (IRRs) of new use (within 182 days) compared to the reference period, 2015-2018, were calculated. Age, sex and comorbidities of users were compared to those of nonusers. Results: In the UK, from 721 271 eligible subjects the IR of new use of low-dose rivaroxaban in the period 2015-2018, before guideline changes, was 12.4 per 100 000 person-years and after guideline changes in 2020-2022 was 124.0 (IRR 10.0, 95% confidence interval [CI] 8.5, 11.8). In the Netherlands from 394 851 subjects, the IR in 2015-2018 was 2.4 per 100 000 person-years and in 2020 was 16.3 (IRR 6.7, 95% CI 4.0, 11.4). Users were younger (UK mean difference [MD]À6.1 years, Netherlands À2.4 years; P < .05) and more likely to be male (UK difference 11.5%, Netherlands 13.4%; P < .001) than nonusers.Conclusions: There was a statistically significant increase in the use of low-dose rivaroxaban for the management of ASCVD after guideline changes in the UK and the Netherlands. There were international differences, but low-dose rivaroxaban has not been put into widespread practice.The principal investigator for this study is Helga Gardarsdottir and there was had the responsibility for the integrity of data and the overall conduct of the study.

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“…In the UK, rivaroxaban utilization in general increased at the pandemic's onset, followed by a deceleration. 33…”

Section: Discussionmentioning

confidence: 99%

Prescribing of low‐dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Hunt

Pajouheshnia

Salih

et al. 2023

Brit J Clinical Pharma

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“…Patient presentations are more likely to appear as escalating or uncontrolled BP and increased number of undiagnosed and diagnosed people with hypertension, which could be detected via BP screening. This trajectory is also supported by reduced use of warfarin and direct-acting oral anticoagulants (DOACs) during the pandemic, 24 , 58 , 59 which is different to the prior long-term trend and hopefully is temporary. The second- and third-order derivative outcomes because of such changes remain to be seen in the clinical data and wider epidemiological findings.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, it could also be an indication that during the early phases of the pandemic, care providers were streamlining care closer to guidelines and the evidence base, in line with the anticoagulation literature indicating reduced use of warfarin and switching to DOACs during the pandemic in response to national guidelines. 24 , 58 , 59 In 2011, the The Prospective Urban Rural Epidemiology (PURE) Study concluded that approaches are needed to improve the long-term use of basic, inexpensive and effective drugs, 8 and this remains the case today.…”

Section: Discussionmentioning

confidence: 99%

“…Not much is known about rates of cardiovascular events in ambulatory patients during the COVID-19 pandemic, nor rates of CVD drug adherence during the lockdown. However, recent evidence is emerging from the United Kingdom that plausibly connects the onset and course of the pandemic to temporal changes in drug series 21 – 24 [for gonadorelins, calcineurin inhibitors, asthma and chronic obstructive pulmonary disease (COPD) medicines, and anticoagulants], trends that are being observed globally, providing an early signal for some form of system fragility or system failure with reduced prescription drug coverage. 25 , 26 …”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on cardiovascular heart disease medication use: time-series analysis of England’s prescription data during the COVID-19 pandemic (January 2019 to October 2020)

Barrett

Hodgkinson

2022

Therapeutic Advances in Cardiovascular Disease

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Background: Management of high blood pressure (BP) typically requires adherence to medication regimes. However, it is known that the COVID-19 pandemic both interrupted access to some routine prescriptions and changed some patient health behaviours. Aim: This study, therefore, retrospectively investigated prescription reimbursement of cardiovascular (CVD) medicines as a proxy measure for patient adherence and access to medicines during the pandemic. Methods: A cohort study of all primary care patients in England prescribed CVD medicines. The exposure was to the global pandemic. Prescriptions were compared before and after the pandemic’s onset. Statistical variation was the outcome of interest. Results: Descriptive statistics show changes to monthly prescriptions, with wide confidence intervals indicating varying underlying practice. Analysis of variance reveals statistically significant differences for bendroflumethiazide, potassium-sparing diuretics, nicorandil, ezetimibe, ivabradine, ranolazine, colesevelam and midodrine. After the pandemic began (March–October 2020), negative parameters are observed for ACE inhibitors, beta-blockers, calcium channel blockers, statins, antiplatelet, antithrombotics, ARBs, loop diuretics, doxazosin, bendroflumethiazide, nitrates and indapamide, indicating decelerating monthly prescription items (statistically significant declines of calcium channel blockers, antithrombotic, adrenoreceptor blockers and diuretics) of CVD medicines within the general population. Many data points are not statistically significant, but fluctuations remain clinically important for the large population of patients taking these medications. Conclusion: A concerning decline in uptake of CVD therapies for chronic heart disease was observed. Accessible screening and treatment alongside financial relief on prescription levies are needed. A video abstract is (4 min 51 s) available: https://bit.ly/39gvEHi

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“…Alkhameys S et al performed an interrupted time series analysis of anticoagulant prescription between January 2019 and February 2021 using the English Prescribing Dataset. Although the prescription of direct-acting oral anticoagulants during the COVID-19 pandemic increased by 19%, the overall prescription of oral anticoagulants during this period was lower than expected, possibly owing to medication adherence [ 16 ]. A recently published questionnaire analysis also revealed that the COVID-19 pandemic significantly impaired the quality of life of patients awaiting AF ablation procedures [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

Zang

Zheng

et al. 2022

JCM

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: The COVID-19 pandemic has severely impacted healthcare systems worldwide. This study investigated cardiologists’ opinions on how the COVID-19 pandemic impacted clinical practice patterns in atrial fibrillation (AF). A multicenter clinician survey, including demographic and clinical questions, was administered to 300 cardiologists from 22 provinces in China, in April 2022. The survey solicited information about their treatment recommendations for AF and their perceptions of how the COVID-19 pandemic has impacted their clinical practice patterns for AF. The survey was completed by 213 cardiologists (71.0%) and included employees in tertiary hospitals (82.6%) and specialists with over 10 years of clinical cardiology practice (53.5%). Most respondents stated that there were reductions in the number of inpatients and outpatients with AF in their hospital during the pandemic. A majority of participants stated that the pandemic had impacted the treatment strategies for all types of AF, although to different extents. Compared with that during the assumed non-pandemic period in the hypothetical clinical questions, the selection of invasive interventional therapies (catheter ablation, percutaneous left atrial appendage occlusion) was significantly decreased (all p < 0.05) during the pandemic. There was no significant difference in the selection of non-invasive therapeutic strategies (the management of cardiovascular risk factors and concomitant diseases, pharmacotherapy for stroke prevention, heart rate control, and rhythm control) between the pandemic and non-pandemic periods (all p > 0.05). The COVID-19 pandemic has had a profound impact on the clinical practice patterns of AF. The selection of catheter ablation and percutaneous left atrial appendage occlusion was significantly reduced, whereas pharmacotherapy was often stated as the preferred option by participating cardiologists.

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Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019–February 2021)

Cited by 6 publications

References 50 publications

Prescribing of low‐dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Prescribing of low‐dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Impact of the COVID-19 pandemic on cardiovascular heart disease medication use: time-series analysis of England’s prescription data during the COVID-19 pandemic (January 2019 to October 2020)

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

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