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Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

Bezabhe, WM ORCID: 0000-0002-3028-6949, Bereznicki, LR ORCID: 0000-0003-3974-3437, Radford, J ORCID: 0000-0002-5751-0488, Wimmer, BC ORCID: 0000-0003-3166-7126, Curtain, C ORCID: 0000-0001-5029-7541, Salahudeen, MS ORCID: 0000-0001-9131-7465 and Peterson, GM ORCID: 0000-0002-6764-3882 2020 , 'Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation' , European Journal of Clinical Investigation , pp. 1-12 , doi: 10.1111/eci.13457.

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Abstract

Background: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF.Methods: Using an Australian nationally representative general practice dataset,MedicineInsight, we identified patients newly diagnosed with AF between January2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice.Results: A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) wereidentified. Nearly two-thirds of these patients (40 854 [64.6%]) were initiated on anOAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2%in 2019 (P 2DS2-VASc, adjusted odds ratio (AOR),4.39 [95% CI, 3.99-4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72-2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65-1.98])and male sex (AOR, 1.29 [95% CI, 1.22-1.35]) were independently associated withOAC initiation. Direct-acting oral anticoagulant (DOAC) use increased from 11.9%in 2011 to 94.0% of all OAC initiations in April 2019 (P Conclusions: The proportion of newly diagnosed patients with AF initiated on OACincreased markedly following the introduction of the DOACs. Of those initiated, 9 in10 were receiving a DOAC at the end of the study period. There is potential underusein women and individuals with dementia.

Item Type: Article
Authors/Creators:Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Curtain, C and Salahudeen, MS and Peterson, GM
Keywords: atrial fibrillation, oral anticoagulant, oral anticoagulant choice, oral anticoagulant initiation, primary care
Journal or Publication Title: European Journal of Clinical Investigation
Publisher: Blackwell Publishing Ltd
ISSN: 0014-2972
DOI / ID Number: 10.1111/eci.13457
Copyright Information:

Copyright 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd

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