scholarly journals Ten-year trends in the use of oral anticoagulants in Australian general practice patients with atrial fibrillation

2020 ◽  
Author(s):  
Woldesellassie Bezabhe ◽  
Luke Bereznicki ◽  
Jan Radford ◽  
Barbabra Wimmer ◽  
Colin Curtain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Oral Anticoagulants ◽  
Australian General Practice

scholarly journals Ten-Year Trends in the Use of Oral Anticoagulants in Australian General Practice Patients With Atrial Fibrillation

2021 ◽  
Vol 12 ◽  
Author(s):  
Woldesellassie M. Bezabhe ◽  
Luke R. Bereznicki ◽  
Jan Radford ◽  
Barbara C. Wimmer ◽  
Colin Curtain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Australian General Practice ◽  
Risk Patients ◽  
General Practices ◽  
Direct Acting

Objective: Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke in patients with atrial fibrillation (AF). The study characterized the prescribing of OACs in people with AF in the Australian primary care setting over 10 years.Design: Retrospective population study.Setting and Participants: We performed 10 sequential cross-sectional analyses of patients with a recorded diagnosis of AF between 2009 and 2018 using national general practice data. The proportion of patients with AF who were prescribed an OAC based on their stroke risk was examined.Primary and secondary outcomes: The primary outcome was the proportion of high stroke risk patients who were prescribed an OAC over a decade. The secondary outcome was variation in OAC prescribing among general practices.Results: The sample size of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The proportion who were prescribed an OAC increased from 39.5% (95% CI 38.6–40.5%) in 2009 to 52.0% (95% CI 51.5–52.4%) in 2018 (p for trend < 0.001). During this time, the proportion of patients with AF and high stroke risk who were prescribed an OAC rose from 41.7% (95% CI 40.7–42.8%) to 55.2% (95% CI 54.7–55.8%; p for trend < 0.001) with the direct-acting oral anticoagulants accounting for over three-quarters of usage by 2018. There was substantial variation in OAC prescribing between general practices. In 2018, the proportion of moderate to high stroke risk patients who were prescribed an OAC was 38.6% (95% CI 37.2–40.1%) in the lowest practice site quintiles and 65.6% (95% CI 64.5–66.7%) in the highest practice site quintiles.Conclusions: Over the 10 years, OAC prescribing in high stroke risk patients with AF increased by one-third. There was considerable variation in OAC prescribing between general practices.

scholarly journals Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

2018 ◽  
Vol 68 (677) ◽  
pp. e844-e851
Author(s):  
Tim A Holt ◽  
Andrew RH Dalton ◽  
Susan Kirkpatrick ◽  
Jenny Hislop ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
General Practice ◽  
Process Evaluation ◽  
Oral Anticoagulants ◽  
Qualitative Interviews ◽  
Randomised Trial ◽  
Software Tool ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

BackgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.AimTo investigate the implementation of the software in UK general practice.Design and settingProcess evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.MethodAn initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.ResultsIn a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.ConclusionAutomated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

scholarly journals Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023130 ◽  
Author(s):  
Jessica J Orchard ◽  
Lis Neubeck ◽  
Ben Freedman ◽  
Ruth Webster ◽  
Anushka Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Oral Anticoagulants ◽  
Qualitative Interviews ◽  
Practice Nurses ◽  
Rural Primary Care ◽  
Electronic Screening ◽  
Human Research Ethics ◽  
Increased Risk ◽  
Registration Number

IntroductionScreening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach.Methods and analysisScreening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3–4 months during 2018–2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a ‘control’ dataset of practices.Ethics and disseminationEthics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.Trial registration numberACTRN12618000004268; Pre-results.

scholarly journals Use of oral anticoagulants in older people with atrial fibrillation in UK general practice: protocol for a cohort study using the Clinical Practice Research Datalink (CPRD) database

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032646
Author(s):  
Anneka Mitchell ◽  
Tomas J Welsh ◽  
Margaret C Watson ◽  
Julia Snowball ◽  
Anita McGrogan
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cohort Study ◽  
Clinical Practice ◽  
Older People ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Standard Data

IntroductionWarfarin has frequently been underused in older people for stroke prevention in atrial fibrillation (AF). Direct oral anticoagulants (DOACs) entered the UK market from 2008 and have been recommended as an alternative to warfarin. This study aimed to describe any changes in the prescribing of oral anticoagulants (OACs) to people aged ≥75 years in UK general practice before and after the introduction of DOACs, to examine differences in patient characteristics which may influence prescribers’ decisions regarding anticoagulation, to evaluate the time people stay on OACs and switching between OACs.Methods and analysisA retrospective cohort study design will be used. Patients with a diagnosis of AF will be identified from the Clinical Practice Research Datalink (CPRD). The study period will run from 1 January 2003 to 27 December 2017. Patients enter the cohort at the latest date of the start of the study period, first AF diagnosis, 75th birthday or a year from when they started to contribute research standard data. Follow-up continues until they leave the practice, death, the date the practice stops contributing research standard data or the end of the study period (27 December 2017). Exposure to OACs will be defined as ≥1 prescription issued for an OAC of interest during the study period. Patients issued an OAC in the year preceding study entry will be defined as ‘prevalent users’. Patients starting on an OAC during the study period will be defined as ‘incident users’. Incidence and prevalence of OAC prescribing, patient demographics and characteristics will be described during three time periods: 2003–2007, 2008–2012 and 2013–2017. Persistence (defined as the time from initiation to discontinuation of medication) with and switching between different OACs will be described.Ethics and disseminationThe protocol for this study was approved by the CPRD Independent Scientific Advisory Committee. The results will be disseminated in a peer-reviewed journal and at conferences.Trial registration numberEUPAS29923.

scholarly journals “Inappropriate Prescriptions of Direct Oral Anticoagulants among Patients with Atrial Fibrillation in General Practice: a Cross-sectional Analysis of the French CACAO Cohort Study”

2020 ◽  
pp. bjgp20X714005
Author(s):  
Emilie Ferrat ◽  
Julie Fabre ◽  
Philippe Galletout ◽  
Emmanuelle Boutin ◽  
Julien Le Breton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
General Practice ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Logistic Models ◽  
Nonvalvular Atrial Fibrillation ◽  
Cross Sectional ◽  
Sectional Analysis ◽  
Inappropriate Prescriptions

Abstract Background: Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with nonvalvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs (especially under-dosing) is the most common problem. However, conflicting results have been reported with regard to the factors independently associated with inappropriate dosing. Aim: The present study’s objectives were to describe inappropriate prescriptions of DOACs in the Comparison of Accidents and Circumstances with Oral Anticoagulants” (CACAO) French nationwide general practice cohort, and to identify factors independently associated with inappropriate DOAC doses. Design and setting: We performed an ancillary cross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant and recruited from April to October 2014. We selected the set of CACAO patients having taken a DOAC for NVAF on inclusion (n=1111). Method: We described inappropriate prescriptions of DOACs (inappropriate dosage, contraindications, non-indications, interactions, and precautions for use) and then used multivariate logistic models to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing). Results: Overall, 438 patients (39.4%) received at least one inappropriate DOAC prescription – mainly an inappropriate dosage (33.7%), and especially under-dosing (31.3%). In a multivariate analysis, the factors independently associated with under-dosing were older age (odds ratio [95% confidence interval] =1.03[1.02-1.05]), prescription of apixaban (3.93[2.29-6.74]) or dabigatran (1.55[1.17-2.06]), and a CHA2DS2-VASc score ≥2 (2.39[0.92-6.18]) vs. a score=1 (0.73[0.23-2.34]). Conclusion: The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, those with kidney failure, a higher risk for ischemic stroke and/or a higher risk for bleeding.

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

Sign in / Sign up

Export Citation Format

Share Document