Rates of Anticoagulation for Atrial Fibrillation

Study Questions:

Has the availability of direct oral anticoagulants (DOACs) increased the rate of oral anticoagulation (OAC) for atrial fibrillation (AF)?

Methods:

The data in this retrospective study were obtained by analysis of 655,000 patients with AF and >1 risk factor for stroke who were enrolled in the National Cardiovascular Data Registry in 2008-2014. Patients with prior valve surgery or a contraindication to OAC were excluded.

Results:

The rate of OAC increased significantly from 52.4% to 60.7% between 2008 and 2014. The use of warfarin decreased from 52.4% to 34.8%, while the use of DOACs increased from 0 to 25.8%. There was major practice-level variation in OAC rates (11-78.8%) and in the use of a DOAC (0-40.4%).

Conclusions:

The rate of OAC has increased modestly with the advent of DOACs, but a large proportion of eligible patients with AF remain unanticoagulated.

Perspective:

It was hoped that there would be a major increase in the utilization of OAC after DOACs were introduced into clinical practice. This large registry study confirms the finding of prior studies indicating that underutilization of OAC still is prevalent in AF patients who are at risk of stroke. Whether this underutilization is driven mostly by patients or by their treating physicians is unclear. However, the large variability in the use of OAC between practices strongly suggests that many physicians are failing to prescribe either warfarin or a DOAC for their eligible patients.


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