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Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up

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, Salahudeen, MS ORCID: 0000-0001-9131-7465, Garrahy, E, Bindoff, I ORCID: 0000-0002-8170-8339 and Peterson, GM ORCID: 0000-0002-6764-3882 2021 , 'Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up' , European Journal of Clinical Investigation , doi: 10.1111/eci.13489.

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Abstract

Aim: To examine the change in stroke risk over time and determine the proportionof patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant(OAC) as their stroke risk increased from low/moderate to high, using the Australiangeneral practice data set, MedicineInsight.Methods: A total of 2296 patients diagnosed with AF between 1 January 2007 and31 December 2008, aged 18 years or older and not initiated on an OAC before 2009,were included. We assessed the change in stroke risk and the proportion of patientswho had a recorded prescription of an OAC, each year from 1 January 2009 to 31December 2018.Results: At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low(score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, usingthe sexless CHA2DS2-VASc (CHA2DS2-VA) score. Overall, the CHA2DS2-VAscore increased by a mean of 1.34 (95% confidence interval, 1.29-1.39) points overthe study period. Nearly two-thirds of patients (65%, 412/632) whose stroke riskchanged from baseline low/moderate to high were subsequently prescribed an OAC.The median (interquartile range) lag time from becoming high stroke risk to havingOAC initiation was 2 (5) years.Conclusions: Nearly one-third of patients reclassified as being at high risk of strokeduring the study period were not prescribed OAC therapy. Furthermore, the delay inOAC initiation following classification as being at high risk was a median of 2 years,suggesting that more frequent stroke reassessment is needed.

Item Type: Article
Authors/Creators:Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Salahudeen, MS and Garrahy, E and Bindoff, I and Peterson, GM
Keywords: Australia, anticoagulation, atrial fibrillation, ischaemic stroke, primary care, reassessment
Journal or Publication Title: European Journal of Clinical Investigation
Publisher: Blackwell Publishing Ltd
ISSN: 0014-2972
DOI / ID Number: 10.1111/eci.13489
Copyright Information:

Copyright 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd

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