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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

Proportion of patients initiating VKA within 3 months following NVAF diagnosis, stratified by age and calendar year of diagnosis
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Fig2: Proportion of patients initiating VKA within 3 months following NVAF diagnosis, stratified by age and calendar year of diagnosis

Mentions: Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA (5.9 % in combination with an antiplatelet and 15.3 % switching from antiplatelet to VKA or adding VKA), 35.5 % received an antiplatelet only, and 17.4 % did not initiate an antithrombotic therapy. The proportion of patients prescribed VKA increased with CHADS2 score. It was 37.8 % for a score of 0, 47.7 % for score of 1, and 49.1 % for patients with a CHADS2 score ≥ 2. Most patients initiating VKA did so in the 15 days following NVAF diagnosis, regardless of age, sex, and CHADS2 score. The proportion of patients initiating VKA within 3 months of diagnosis increased from 33.5 % to 39 % over the 10-year study period independently of age and CHADS2 score (p < 0.0001). This increased use of VKA was mainly driven by a higher proportion of treated patients aged 80 or more (from 29 % to 41 %) (Fig. 2). At the end of the study period, women were prescribed VKA as frequently as men shortly after NVAF diagnosis, except in the subgroup of patients with a low risk of ischemic stroke (Figs. 3 and 4). The hazard ratios of initiating VKA within 3 months of NVAF diagnosis according to baseline characteristics are presented in Table 2. Older patients as well as those with a previous ischemic stroke, congestive heart failure, or cardiovascular medication use were more likely to initiate VKA in the first 3 months after diagnosis. Men were also slightly more likely to initiate VKA shortly after NVAF diagnosis than women. However, when restricting the analysis to patients 75 years or older, there was no difference between men and women (HR 1.01, 95 % CI 0.99-1.04). As expected, patients with a prior bleeding event, dementia, liver disease, or chronic renal failure were less likely to initiate VKA.Fig. 2


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)

Proportion of patients initiating VKA within 3 months following NVAF diagnosis, stratified by age and calendar year of diagnosis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Proportion of patients initiating VKA within 3 months following NVAF diagnosis, stratified by age and calendar year of diagnosis
Mentions: Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA (5.9 % in combination with an antiplatelet and 15.3 % switching from antiplatelet to VKA or adding VKA), 35.5 % received an antiplatelet only, and 17.4 % did not initiate an antithrombotic therapy. The proportion of patients prescribed VKA increased with CHADS2 score. It was 37.8 % for a score of 0, 47.7 % for score of 1, and 49.1 % for patients with a CHADS2 score ≥ 2. Most patients initiating VKA did so in the 15 days following NVAF diagnosis, regardless of age, sex, and CHADS2 score. The proportion of patients initiating VKA within 3 months of diagnosis increased from 33.5 % to 39 % over the 10-year study period independently of age and CHADS2 score (p < 0.0001). This increased use of VKA was mainly driven by a higher proportion of treated patients aged 80 or more (from 29 % to 41 %) (Fig. 2). At the end of the study period, women were prescribed VKA as frequently as men shortly after NVAF diagnosis, except in the subgroup of patients with a low risk of ischemic stroke (Figs. 3 and 4). The hazard ratios of initiating VKA within 3 months of NVAF diagnosis according to baseline characteristics are presented in Table 2. Older patients as well as those with a previous ischemic stroke, congestive heart failure, or cardiovascular medication use were more likely to initiate VKA in the first 3 months after diagnosis. Men were also slightly more likely to initiate VKA shortly after NVAF diagnosis than women. However, when restricting the analysis to patients 75 years or older, there was no difference between men and women (HR 1.01, 95 % CI 0.99-1.04). As expected, patients with a prior bleeding event, dementia, liver disease, or chronic renal failure were less likely to initiate VKA.Fig. 2

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