NCDR Study Finds Underuse of OAC For AFib Patients at High Risk For Stroke

Approximately four in 10 patients with atrial fibrillation (AFib) may not be prescribed to, or take the right dosage of, oral anticoagulants (OACs) to prevent their risk of stroke, according to a study published May 15 in the Journal of the American College of Cardiology. Consequently, hundreds of thousands of AFib patients may have preventable strokes each year.

Lucas Marzec, MD, et al., used ACC’s PINNACLE Registry to identify 655,000 patients who had non-valvular AFib and a CHA₂DS₂-VASc score of >1 between April 1, 2008 and Sept. 30, 2014. The authors examined what effect the availability of direct oral anticoagulants (DOACs) had on overall OAC rates.

Results showed that overall OAC rates only increased slightly, from 52.4 percent to 60.7 percent over the seven-year study period. The authors also found that younger, healthier AFib patients were more likely to be prescribed a DOAC. Additionally, they found significant practice-level variation in the consistent use of any OACs or DOACs. Practices using OACs ranged from 11 percent to 78.8 percent, while practices using DOACs ranged from zero to 40.4 percent. The findings suggest that DOAC availability alone will not result in optimal OAC use in AFib patients.

While DOACs have been found to be equivalent or more effective than OACs, “there are still wide disparities in how they are prescribed,” says Marzec. “For example, we found that patients at the highest risk of stroke were the least likely to be treated with a DOAC.”

Marzec concludes that, “We need to continue to support research to better understand why OACs are not being prescribed to people who need them, so ultimately we reduce strokes in patients at risk.”

In a related editorial comment, Eric D. Peterson, MD, MPH, FACC, and Sean D. Pokorney, MD, MBA, note “the current analysis provides a sobering message to clinicians” and “should incite an urgent call to action.” Since the results found providers to be the strongest predictor of OAC use and adoption of DOACs, they highlight the need for “examination of ‘leading versus lagging’ centers to identify practices and processes that lead to more consistent evidence-based care.”


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