Aurora, CO—Too many atrial fibrillation patients aren’t receiving guideline-concordant therapy, and the introduction of direct oral anticoagulants at the beginning of this decade hasn’t made as much difference as expected, a new review suggests.
The study in the Journal of the American College of Cardiology points out that use of oral anticoagulants (OACs) can reduce stroke risk by two-thirds in patients with irregular heartbeat. Direct oral anticoagulants (DOAC) can provide the same results, usually with less monitoring necessary.
“When DOAC’s were first introduced in 2010, there was an increase in use of oral anticoagulation,” explained lead author Lucas N. Marzec, MD, a clinical cardiac electrophysiologist at the University of Colorado and researcher with the Colorado Cardiovascular Outcomes Research Consortium in Aurora. “However, there are still wide disparities in how they are prescribed. For example, we found that patients at the highest risk of stroke were the least likely to be treated with a DOAC.”
To reach that conclusion, the researchers reviewed data from the National Cardiovascular Data Registry PINNACLE registry, focusing on 655,000 patients who were treated at cardiologists’ offices for atrial fibrillation. Results indicate that, over the nearly 7-year study period, use of OACs didn’t increase as much as anticipated, considering the availability of new alternatives.
In fact, prescriptions for the drugs rose only from 52.4% to 60.7% for patients who met the criteria to use OACs for stroke prevention. The upshot: 40% of atrial fibrillation patients with elevated stroke risk still weren’t receiving therapy.
Study authors also cite previous research noting that patients prescribed DOACs often get dosages that are too low or otherwise inappropriate.
The review uncovered significant variations in how often patients are prescribed OACs and DOACs. While some physician practices consistently used OACs in up to 70% of cases, prescribing in others is as low as 10%. Furthermore, while some doctors opt for DOACs in nearly 40% of situations, other almost never prescribe them.
“We need to continue to support research to better understand why OACs are not being prescribed to the people who need them, so ultimately we reduce strokes in patients at risk,” Marzec said.
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