Trends in the Prescription of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation: Results of the Polish Atrial Fibrillation (POL-AF) Registry

Abstract

Background: Current guidelines do not suggest in which groups of patients with atrial fibrillation (AF) individual non-vitamin K antagonist oral anticoagulants (NOACs) should be used for the prevention of thromboembolic complications. The aim of this study was to evaluate the frequency of use of apixaban, dabigatran, and rivaroxaban, and attempt to identify factors predisposing their administration. Methods: The Polish Atrial Fibrillation (POL-AF) registry is a prospective, non-interventional study, including consecutive patients with AF hospitalized in ten Polish cardiology centers during the period ranging from January to December 2019. In this study, all patients were treated with NOACs. Results: Among the 2971 patients included in the analysis, 40.4% were treated with rivaroxaban, 32% with apixaban, and 27.6% with dabigatran. The mean age of the total population was 72 ± 11.5 years and 43% were female. A reduced dose of NOAC was used in 35% of patients treated with apixaban, 39.7% of patients treated with dabigatran, and 34.4% of patients treated with rivaroxaban. Independent predictors of apixaban prescription were previous bleeding (OR 2.39, CI 1.69–3.38), GFR < 60 mL/min (OR 1.52, CI 1.28–1.81), and age (per 5 years) (OR 1.13, CI 1.08–1.18), whereas for rivaroxaban the predictor was non-permanent AF (OR 1.24, CI 1.03–1.49) and for dabigatran it was vascular disease (OR 1.22, CI 1.02–1.46). Conclusions: In hospitalized patients with AF, the most frequently chosen NOAC was rivaroxaban. Apixaban was chosen more often in patients after bleeding, and in those who were advanced in years, with heart failure and impaired renal function. Impaired renal function and female gender were factors that diminished the chance of using dabigatran. Previous bleeding and vascular disease was the factor that diminished the chance of using rivaroxaban. Dabigatran and rivaroxaban have been used less frequently in elderly patients.

Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry

“…The analysis was carried out on a group of patients from the Polish Atrial Fibrillation (POL-AF) registry. The methodology has been previously described in detail [9,10]. The POL-AF registry is a prospective, observational, multicenter study.…”

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

“…A similar trend was also noted in the 2017-2018 analysis of other European populations [40], as well as in the population of Central Europe, which is represented by the Poles. In 2019, in a large Polish registry, 84% of patients with AF were treated with NOACs [41]. Confirming the validity of the findings from the registries and subsequent randomized data, the 2020 recommendations for the management of patients with AF unequivocally indicate that NOACs should be the preferred group of drugs for antithrombotic prophylaxis [17].…”

Characteristics and Treatment of Atrial Fibrillation with Respect to the Presence or Absence of Heart Failure. Insights from the Multicenter Polish Atrial Fibrillation (POL-AF) Registry

“…The POL-AF Registry (NCT04419012) was a prospective, observational study enrolling AF patients hospitalized in 10 cardiology departments (eight academic centers and two territorial centers) in Poland. Details on the study design and main results have been reported elsewhere [5,6]. Briefly, consecutive hospitalized patients in cardiology centers diagnosed with AF, except those admitted for AF ablation (in centers with electrotherapy labs), were included in the registry.…”