Trends in oral anticoagulant use in patients with atrial fibrillation in Belgium from 2013 to 2019: A nationwide cohort study

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly preferred over vitamin K antagonists (VKAs) in atrial fibrillation (AF) management. However, differences in oral anticoagulant (OAC) prescribing according to patient's age, sex and physician's specialty may be present. Therefore, incident and prevalent use of OACs, NOACs and VKAs, stratified by age, sex and prescriber, and factors associated with the choice of OAC were investigated. Methods: Using two Belgian nationwide healthcare databases, AF patients ≥45 years old with ≥1 OAC prescription claim between 2013 and 2019 were identified. OAC use was investigated per half-year. Factors influencing NOAC vs. VKA initiation were identified by multivariable logistic regression. Results: Among 448 661 included OAC-treated AF patients, 297 818 were newly treated. Incident OAC use ranged from 45-49 to 42-44 users/10 000 persons between 2013 and 2019, whereas prevalent OAC use increased from 337 to 435 users/10 000 persons. Incident and prevalent NOAC use exceeded VKA use since 2013 and 2015, respectively, and NOACs represented 92% of incident and 81% of prevalent OAC users in 2019. Apixaban was the most frequently used NOAC since 2016. NOACs were significantly more prescribed by cardiologists and to older patients, whereas VKAs were more initiated in patients with cardiovascular, renal and hepatic comorbidities. Prevalent OAC use increased less in women than men (25.3% vs. 33.0% between 2013 and 2019) and female subjects had 5% significantly lower odds of NOAC vs. VKA initiation than men. Conclusion: Since 2013, prevalent anticoagulant use increased almost one third in Belgium, while incident use was stable. Potential (N)OAC underuse in women requires further exploration.Principal Investigator statement The authors confirm that the principal investigators for this paper are Lies Lahousse and Maxim Grymonprez. No patients were directly involved.

The Impact of Polypharmacy on the Effectiveness and Safety of Non-vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

“…Details on the study methodology have been published before and are provided in the Supplementary Materials (available in the online version) . 13,20 In brief, two nationwide databases provided the source population, namely the InterMutualistic Agency (IMA) database and Minimal Hospital Dataset (MHD).…”

Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists: a Belgian nationwide cohort study

“…Details on the study methodology have been published before and are provided in the supplemental materials [ 17 , 25 ]. In brief, two nationwide databases provided the source population, namely the InterMutualistic Agency (IMA) database and Minimal Hospital Dataset (MHD).…”

“…From 1 January 2013 to 1 January 2019, persons aged ≥45 years old and with ≥1 year coverage by a health insurance fund were included from the IMA database on the first date of filling an OAC prescription (=index date) ( Figure S1 ). NOAC users, namely dabigatran (approved in Belgium since August 2012), rivaroxaban (approved since September 2012), apixaban (approved since September 2013) and edoxaban (approved since October 2016), and VKA users (warfarin, acenocoumarol, phenprocoumon) were included [ 17 ]. Only OAC-naïve subjects were considered, excluding OAC-experienced subjects with an OAC prescription filled ≤1 year before the index date.…”

“…Following the rapid uptake of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in AF [ 16 , 17 ], the question has been raised whether NOACs may additionally reduce the risk of dementia compared with vitamin K antagonists (VKAs), given that they are associated with significantly lower risks of stroke and intracranial bleeding compared with VKAs [ 1 , 2 , 8 , 11 , 14 , 18–21 ]. However, strong randomised evidence is currently lacking and previous real-world observational studies have reported conflicting results [ 1 , 5 , 12 , 13 , 20–24 ].…”

Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study

“…Details on the study methodology have been reported before [7] , [19] , [20] . In brief, two nationwide databases, the InterMutualistic Agency (IMA) database and Minimal Hospital Dataset (MHD), provided the source population.…”