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Long-term vitamin K antagonists treatment patterns of Non-Valvular Atrial Fibrillation (NVAF): a population-based cohort study.

Renoux C, Coulombe J, Suissa S - BMC Cardiovasc Disord (2016)

Bottom Line: Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA, 35.5 % received an antiplatelet only, and 17.4 % did not initiate antithrombotic therapy.Also the gap in treatment between men and women has been closing within the last decade.Once initiated, most VKA interruptions were temporary rather than definitive.

View Article: PubMed Central - PubMed

Affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montréal, Québec, H3T 1E2, Canada.

ABSTRACT

Background: Recent trends in vitamin K antagonists (VKA) use in non-valvular atrial fibrillation (NVAF) are useful to evaluate the potential improvement in management of NVAF since the introduction of new oral anticoagulants. Our objective was therefore to describe the contemporary VKA treatment patterns following NVAF diagnosis.

Methods and results: We used the computerized databases of the Régie de l'assurance maladie du Québec (RAMQ), responsible for administering the universal health care services for all its residents, to identify a population-based cohort of 135,241 patients with an incident diagnosis of NVAF during 2000-2009 and RAMQ medication coverage. Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA, 35.5 % received an antiplatelet only, and 17.4 % did not initiate antithrombotic therapy. The proportion of patients initiating VKA within 3 months of diagnosis increased from 33 % to 39 % over the 10-year study period, mainly driven by a higher proportion of treated patients aged 80 or more (from 29 % to 41 %). At the end of the study period, women were prescribed VKA as frequently as men, except in the subgroup of patients with a low risk of ischemic stroke. The median time from VKA initiation to the first discontinuation varied greatly according to the definition of discontinuation, ranging from 11 months to 5.7 years.

Conclusion: Although VKA remain underused after NVAF diagnosis, there has been an increase in VKA treatment over the last decade, particularly among older patients. Also the gap in treatment between men and women has been closing within the last decade. Once initiated, most VKA interruptions were temporary rather than definitive.

No MeSH data available.


Related in: MedlinePlus

Details of incident non-valvular atrial fibrillation (NVAF) cohort definition
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Fig1: Details of incident non-valvular atrial fibrillation (NVAF) cohort definition

Mentions: The source population included 309,556 subjects with at least one atrial fibrillation diagnosis code during the period 2000-2009. From these, we identified 135,241 patients with a first NVAF diagnosis, satisfying cohort inclusions and exclusions, and having drug insurance coverage for a minimum of two years at the time of cohort entry (Fig. 1). Table 1 describes the baseline characteristics of this incident NVAF cohort. NVAF was a hospital diagnosis in 47.8 % of the patients and the mean follow-up was 3.3 years. The mean age at NVAF diagnosis was 75.1 years, 74.8 % of the patients were 70 years or older at diagnosis, and 47.9 % were males. Women were older at NVAF diagnosis, and had a higher CHADS2 score at baseline. However, the prevalence of most comorbidities such as myocardial infarction, diabetes, hyperlipidemia, and chronic renal failure was higher in males compared to women. Patient initiating an antithrombotic treatment within 3 months following NVAF diagnosis were older and had more cardio- and cerebrovascular comorbidities than patients who were not prescribed VKA or antiplatelets.Fig. 1


Long-term vitamin K antagonists treatment patterns of Non-Valvular Atrial Fibrillation (NVAF): a population-based cohort study.

Renoux C, Coulombe J, Suissa S - BMC Cardiovasc Disord (2016)

Details of incident non-valvular atrial fibrillation (NVAF) cohort definition
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862088&req=5

Fig1: Details of incident non-valvular atrial fibrillation (NVAF) cohort definition
Mentions: The source population included 309,556 subjects with at least one atrial fibrillation diagnosis code during the period 2000-2009. From these, we identified 135,241 patients with a first NVAF diagnosis, satisfying cohort inclusions and exclusions, and having drug insurance coverage for a minimum of two years at the time of cohort entry (Fig. 1). Table 1 describes the baseline characteristics of this incident NVAF cohort. NVAF was a hospital diagnosis in 47.8 % of the patients and the mean follow-up was 3.3 years. The mean age at NVAF diagnosis was 75.1 years, 74.8 % of the patients were 70 years or older at diagnosis, and 47.9 % were males. Women were older at NVAF diagnosis, and had a higher CHADS2 score at baseline. However, the prevalence of most comorbidities such as myocardial infarction, diabetes, hyperlipidemia, and chronic renal failure was higher in males compared to women. Patient initiating an antithrombotic treatment within 3 months following NVAF diagnosis were older and had more cardio- and cerebrovascular comorbidities than patients who were not prescribed VKA or antiplatelets.Fig. 1

Bottom Line: Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA, 35.5 % received an antiplatelet only, and 17.4 % did not initiate antithrombotic therapy.Also the gap in treatment between men and women has been closing within the last decade.Once initiated, most VKA interruptions were temporary rather than definitive.

View Article: PubMed Central - PubMed

Affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montréal, Québec, H3T 1E2, Canada.

ABSTRACT

Background: Recent trends in vitamin K antagonists (VKA) use in non-valvular atrial fibrillation (NVAF) are useful to evaluate the potential improvement in management of NVAF since the introduction of new oral anticoagulants. Our objective was therefore to describe the contemporary VKA treatment patterns following NVAF diagnosis.

Methods and results: We used the computerized databases of the Régie de l'assurance maladie du Québec (RAMQ), responsible for administering the universal health care services for all its residents, to identify a population-based cohort of 135,241 patients with an incident diagnosis of NVAF during 2000-2009 and RAMQ medication coverage. Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA, 35.5 % received an antiplatelet only, and 17.4 % did not initiate antithrombotic therapy. The proportion of patients initiating VKA within 3 months of diagnosis increased from 33 % to 39 % over the 10-year study period, mainly driven by a higher proportion of treated patients aged 80 or more (from 29 % to 41 %). At the end of the study period, women were prescribed VKA as frequently as men, except in the subgroup of patients with a low risk of ischemic stroke. The median time from VKA initiation to the first discontinuation varied greatly according to the definition of discontinuation, ranging from 11 months to 5.7 years.

Conclusion: Although VKA remain underused after NVAF diagnosis, there has been an increase in VKA treatment over the last decade, particularly among older patients. Also the gap in treatment between men and women has been closing within the last decade. Once initiated, most VKA interruptions were temporary rather than definitive.

No MeSH data available.


Related in: MedlinePlus