Trends in Anticoagulant Prescribing in Patients with AF Aged 65 Years and Over

Pavankumar Kamat

Disclosures

October 06, 2021

  • The use of anticoagulant prescriptions for atrial fibrillation (AF) increased across all age groups over the period from 2008 to 2018, with the highest increase seen in those aged ≥85 years, both in terms of initiation and persistence than previously reported.

  • Direct oral anticoagulants (DOACs) were the major class of anticoagulants prescribed to patients with newly diagnosed AF.

  • Long-term persistence with DOACs was higher than that with warfarin in patients with AF aged <85 years but falls in all age groups over a 5-year period.

Why this matters

  • According to the UK National Screening Committee, insufficient evidence regarding anticoagulant prescribing patterns, compliance and persistence is one of the potential barriers to a national screening programme for AF.

Study design

  • A cohort study of 42,290 participants who were diagnosed with AF (age, ≥65 years; women, 20,850 [49%]) between 2008 and 2018, identified from the UK Clinical Practice Research Datalink (CPRD).

  • All participants were categorised into 3 age groups based on age at AF diagnosis:

    • 65-74 years: n=11,722;

    • 75-84 years: n=19,055; and

    • ≥85 years: n=11,513.

  • Funding: None.

Key results

  • Rates of anticoagulant prescriptions at AF diagnosis increased over the period from:

    • 55 to 86% in those aged 65-74 years;

    • 54 to 86% in those aged 75-84 years; and

    • 27 to 74% in those aged ≥85 years.

  • Overall, 1222 of 1319 (92%) patients with newly diagnosed AF received DOACs as a first-line anticoagulant.

  • At 5 years, the survivor function for anticoagulants was:

    • 0.79 (95% CI, 0.78-0.81) in those aged 65-74 years;

    • 0.73 (95% CI, 0.72-0.75) in those aged 75-84 years; and

    • 0.58 (95% CI, 0.54-0.61) in those aged ≥85 years.

  • Survivor function for 5-year persistence was 0.79 (95% CI, 0.77-0.82) in patients with AF who were prescribed a DOAC vs 0.71 (95% CI, 0.71-0.76) in those who were prescribed warfarin.

Limitations

  • Anticoagulant prescription was a marker for persistence with medication.

 

Lund J, Saunders CL, Edwards D, Mant J. Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study. Open Heart. 2021;8(2):e001737. doi: 10.1136/openhrt-2021-001737. PMID: 34344724  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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