Initiation of rivaroxaban in patients with nonvalvular atrial fibrillation at the primary care level: The Swiss Therapy in Atrial Fibrillation for the Regulation of Coagulation (STAR) Study

Background: Rivaroxaban has become an alternative to vitamin-K antagonists (VKA) for stroke prevention in non-valvular atrial fibrillation (AF) patients due to its favourable risk-benefit profile in the restrictive setting of a large randomized trial. However in the primary care setting, physician's motivation to begin with rivaroxaban, treatment satisfaction and the clinical event rate after the initiation of rivaroxaban are not known. Methods: Prospective data collection by 115 primary care physicians in Switzerland on consecutive nonvalvular AF patients with newly established rivaroxaban anticoagulation with 3-month follow-up. Results: We enrolled 537 patients (73 +/- 11 years, 57% men) with mean CHADS2 and HAS-BLED-scores of 2.2 +/- 1.3 and 2.4 +/- 1.1, respectively: 301(56%) were switched from VKA to rivaroxaban (STR-group) and 236(44%) were VKA-naive (VN-group). Absence of routine coagulation monitoring (68%) and fixed-dose once-daily treatment (58%) were the most frequent criteria for physicians to initiate rivaroxaban. In the STR-group, patient's satisfaction increased from 3.6 +/- 1.4 under VKA to 5.5 +/- 0.8 points (P < 0.001), and overall physician satisfaction from 3.9 +/- 1.3 to 5.4 +/- 0.9 points (P < 0.001) at 3months of rivaroxaban therapy (score from 1 to 6 with higher scores indicating greater satisfaction). In the VN-group, both patient's (5.4 +/- 0.9) and physician's satisfaction (5.5 +/- 0.7) at follow-up were comparable to the STR-group. During follow-up, 1(0.19%; 95% CI, 0.01-1.03%) ischemic stroke, 2(0.37%; 95% CI, 0.05-1.34%) major non-fatal bleeding and 11(2.05%; 95% CI, 1.03-3.64%) minor bleeding complications occurred. Rivaroxaban was stopped in 30(5.6%) patients, with side effects being the most frequent reason. Conclusion: Initiation of rivaroxaban for patients with nonvalvular AF by primary care physicians was associated with a low clinical event rate and with high overall patient's and physician's satisfaction. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.