Inadequate stroke prevention in Korean atrial fibrillation patients in the post-warfarin era

被引:19
作者
Choi, Eun Joo [1 ]
Lee, Iyn-Hyang [2 ]
Je, Nam Kyung [3 ]
机构
[1] Chosun Univ, Coll Pharm, Gwangju, South Korea
[2] Yeungnam Univ, Coll Pharm, Gyongsan, South Korea
[3] Pusan Natl Univ, Coll Pharm, Busandaehakro 63 Bungil 2, Busan 609735, South Korea
基金
新加坡国家研究基金会;
关键词
Atrial fibrillation; Stroke; Warfarin; DOACs; Underutilization; ORAL ANTICOAGULANTS; ANTITHROMBOTIC MANAGEMENT; MEDICARE BENEFICIARIES; RISK STRATIFICATION; ISCHEMIC-STROKE; UNDERUSE; THERAPY; THROMBOEMBOLISM;
D O I
10.1016/j.ijcard.2016.06.177
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Anticoagulation therapy with warfarin or direct oral anticoagulants (DOACs) is recommended for atrial fibrillation (AF) patients who are at a high risk for stroke. This study aimed to investigate the utilization of anticoagulants since the introduction of DOACs in South Korea. Methods: This was a cross-sectional study using claim-based national data from 2011 to 2014 derived from the Aged Patient Sample (APS) compiled by the Health Insurance Review & Assessment Service (HIRA). Patients with a high risk for thromboembolismwere identified as those having a CHA2DS2-VASc (congestive heart failure, hypertension, age >= 75, diabetesmellitus, stroke (or transient ischemic attack), vascular disease, sex) score of >= 2. Patients at a high risk for bleeding with an ATRIA (anticoagulation and risk factors in atrial fibrillation) bleeding score of >4 were excluded. Anticoagulant underutilization was estimated in these high-risk patients. Demographic and clinical factors associated with warfarin and DOAC underutilization were explored using a logistic regression model. Results: Anticoagulant underutilization among high-risk patients for stroke decreased from 68% to 62.5% between 2011 and 2014; however, there was further scope for improvement. The risk factors for underutilization were identified as follows: female sex, old age, having medical aid insurance, presence of vascular disease, and limited anticoagulant options. Conclusions: Our study demonstrates that a large population of AF patients in South Korea failed to obtain adequate stroke prevention treatment, even in the era of DOAC usage. A more aggressive approach to provide optimal antithrombotic therapy is warranted. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:647 / 652
页数:6
相关论文
共 46 条
[1]   Oral Anticoagulant Therapy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J].
Ageno, Walter ;
Gallus, Alexander S. ;
Wittkowsky, Ann ;
Crowther, Mark ;
Hylek, Elaine M. ;
Palareti, Gualtiero .
CHEST, 2012, 141 (02) :E44S-E88S
[2]   New oral anticoagulant drugs in cardiovascular disease [J].
Ahrens, Ingo ;
Lip, Gregory Y. H. ;
Peter, Karlheinz .
THROMBOSIS AND HAEMOSTASIS, 2010, 104 (01) :49-60
[3]  
[Anonymous], 2016, JAMA CARDIOL
[4]  
[Anonymous], 2014, CIRCULATION, DOI DOI 10.1161/01.cir.0000441139.02102.80
[5]  
[Anonymous], 2014, PRIME REP
[6]  
[Anonymous], J CARDIOL
[7]   An international longitudinal registry of patients with atrial fibrillation at risk of stroke (GARFIELD): the UK protocol [J].
Apenteng, Patricia N. ;
Murray, Ellen T. ;
Holder, Roger ;
Hobbs, F. D. Richard ;
Fitzmaurice, David A. .
BMC CARDIOVASCULAR DISORDERS, 2013, 13
[8]   Present Status of Anticoagulation Treatment in Japanese Patients With Atrial Fibrillation - A Report From the J-RHYTHM Registry [J].
Atarashi, Hirotsugu ;
Inoue, Hiroshi ;
Okumura, Ken ;
Yamashita, Takeshi ;
Kumagai, Naoko ;
Origasa, Hideki .
CIRCULATION JOURNAL, 2011, 75 (06) :1328-1333
[9]   Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation [J].
Birman-Deych, E ;
Radford, MJ ;
Nilasena, DS ;
Gage, BF .
STROKE, 2006, 37 (04) :1070-1074
[10]   2012 focused update of the ESC Guidelines for the management of atrial fibrillation [J].
Camm, A. John ;
Lip, Gregory Y. H. ;
De Caterina, Raffaele ;
Savelieva, Irene ;
Atar, Dan ;
Hohnloser, Stefan H. ;
Hindricks, Gerhard ;
Kirchhof, Paulus ;
Bax, Jeroen J. ;
Baumgartner, Helmut ;
Ceconi, Claudio ;
Dean, Veronica ;
Deaton, Christi ;
Fagard, Robert ;
Funck-Brentano, Christian ;
Hasdai, David ;
Hoes, Arno ;
Knuuti, Juhani ;
Kolh, Philippe ;
McDonagh, Theresa ;
Moulin, Cyril ;
Popescu, Bogdan A. ;
Reiner, Zeljko ;
Sechtem, Udo ;
Sirnes, Per Anton ;
Tendera, Michal ;
Torbicki, Adam ;
Vahanian, Alec ;
Windecker, Stephan ;
Vardas, Panos ;
Al-Attar, Nawwar ;
Alfieri, Ottavio ;
Angelini, Annalisa ;
Blomstrom-Lundqvist, Carina ;
Colonna, Paolo ;
De Sutter, Johan ;
Ernst, Sabine ;
Goette, Andreas ;
Gorenek, Bulent ;
Hatala, Robert ;
Heidbuchel, Hein ;
Heldal, Magnus ;
Kristensen, Steen Dalby ;
Le Heuzey, Jean-Yves ;
Mavrakis, Hercules ;
Mont, Lluis ;
Filardi, Pasquale Perrone ;
Ponikowski, Piotr ;
Prendergast, Bernard ;
Rutten, Frans H. .
EUROPEAN HEART JOURNAL, 2012, 33 (21) :2719-2747