Stefan H Hohnloser1, Edin Basic2, Michael Nabauer3. 1. Division Clinical Electrophysiology, Department of Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany. Hohnloser@em.uni-frankfurt.de. 2. Pfizer Deutschland GmbH, Berlin, Germany. 3. Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
Abstract
BACKGROUND: Underuse of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) results in thousands of preventable strokes in Germany each year. This study aimed to assess changes in antithrombotic therapy in AF patients after increased use of direct oral anticoagulants (DOACs) in Germany and to evaluate whether the adoption of DOAC therapy was associated with changes in AF-related stroke and bleeding over time. METHODS: Analyses were carried out on a large claims-based dataset of 4 million health-insured Germans. The study population consisted of 601,261 prevalent AF patients between 2011 and 2016 who were assigned to one of the following four treatment groups: DOAC, VKA, antiplatelets or no antithrombotic treatment. Treatment patterns were descriptively analysed and represented by cohort and CHA2DS2-VASc score. Clinical outcomes before and after the adoption of DOAC therapy were assessed using Poisson regression models. RESULTS: Use of OAC increased from 42 to 61% between 2011 and 2016, mainly due to more frequent prescription of DOACs. However, some underuse of OAC therapy remained even in high risk AF patients. In parallel with the increased prescription rate of OAC, there was an overall 24% incidence reduction in stroke between 2011 and 2016 which was mainly driven by reductions in ischemic strokes. Over the same time period the risk for major bleeding remained unchanged. CONCLUSION: Between 2011 and 2016, the use of guideline-conform antithrombotic therapy in Germany has significantly increased. This was associated with a significant decline in strokes without an increased incidence of bleeding complications.
BACKGROUND: Underuse of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) results in thousands of preventable strokes in Germany each year. This study aimed to assess changes in antithrombotic therapy in AFpatients after increased use of direct oral anticoagulants (DOACs) in Germany and to evaluate whether the adoption of DOAC therapy was associated with changes in AF-related stroke and bleeding over time. METHODS: Analyses were carried out on a large claims-based dataset of 4 million health-insured Germans. The study population consisted of 601,261 prevalent AFpatients between 2011 and 2016 who were assigned to one of the following four treatment groups: DOAC, VKA, antiplatelets or no antithrombotic treatment. Treatment patterns were descriptively analysed and represented by cohort and CHA2DS2-VASc score. Clinical outcomes before and after the adoption of DOAC therapy were assessed using Poisson regression models. RESULTS: Use of OAC increased from 42 to 61% between 2011 and 2016, mainly due to more frequent prescription of DOACs. However, some underuse of OAC therapy remained even in high risk AFpatients. In parallel with the increased prescription rate of OAC, there was an overall 24% incidence reduction in stroke between 2011 and 2016 which was mainly driven by reductions in ischemic strokes. Over the same time period the risk for major bleeding remained unchanged. CONCLUSION: Between 2011 and 2016, the use of guideline-conform antithrombotic therapy in Germany has significantly increased. This was associated with a significant decline in strokes without an increased incidence of bleeding complications.
Entities:
Keywords:
Atrial fibrillation; Direct oral anticoagulants; Oral anticoagulation; Stroke; VKA
Authors: Paulus Kirchhof; Stefano Benussi; Dipak Kotecha; Anders Ahlsson; Dan Atar; Barbara Casadei; Manuel Castella; Hans-Christoph Diener; Hein Heidbuchel; Jeroen Hendriks; Gerhard Hindricks; Antonis S Manolis; Jonas Oldgren; Bogdan Alexandru Popescu; Ulrich Schotten; Bart Van Putte; Panagiotis Vardas Journal: Eur Heart J Date: 2016-08-27 Impact factor: 29.983
Authors: Matylda Zimny; Steffen Blum; Peter Ammann; Paul Erne; Giorgio Moschovitis; Marcello Di Valentino; Dipen Shah; Jürg Schläpfer; Cyrill Vogt; Alexandra Tabord; Michael Kühne; Christian Sticherling; Stefan Osswald; David Conen Journal: Swiss Med Wkly Date: 2017-02-09 Impact factor: 2.193
Authors: Tomas Forslund; Joris J Komen; Morten Andersen; Björn Wettermark; Mia von Euler; Aukje K Mantel-Teeuwisse; Frieder Braunschweig; Paul Hjemdahl Journal: Stroke Date: 2018-09 Impact factor: 7.914
Authors: Sigrun Halvorsen; Dan Atar; Hongqiu Yang; Raffaele De Caterina; Cetin Erol; David Garcia; Christopher B Granger; Michael Hanna; Claes Held; Steen Husted; Elaine M Hylek; Petr Jansky; Renato D Lopes; Witold Ruzyllo; Laine Thomas; Lars Wallentin Journal: Eur Heart J Date: 2014-02-20 Impact factor: 29.983
Authors: Gabriel S C Yiin; Dominic P J Howard; Nicola L M Paul; Linxin Li; Ziyah Mehta; Peter M Rothwell Journal: J Neurol Neurosurg Psychiatry Date: 2015-10-20 Impact factor: 10.154
Authors: J Campbell Cowan; Jianhua Wu; Marlous Hall; Andi Orlowski; Robert M West; Chris P Gale Journal: Eur Heart J Date: 2018-08-21 Impact factor: 35.855
Authors: Emma Thorén; Mona-Lisa Wernroth; Christina Christersson; Karl-Henrik Grinnemo; Lena Jidéus; Elisabeth Ståhle Journal: Clin Res Cardiol Date: 2020-02-08 Impact factor: 5.460
Authors: Serdar Tütüncü; Manuel Olma; Claudia Kunze; Joanna Dietzel; Johannes Schurig; Cornelia Fiessler; Carolin Malsch; Tobias Eberhard Haas; Boris Dimitrijeski; Wolfram Doehner; Georg Hagemann; Frank Hamilton; Martin Honermann; Gerhard Jan Jungehulsing; Andreas Kauert; Hans-Christian Koennecke; Bruno-Marcel Mackert; Darius Nabavi; Christian H Nolte; Joschua Mirko Reis; Ingo Schmehl; Paul Sparenberg; Robert Stingele; Enrico Völzke; Carolin Waldschmidt; Daniel Zeise-Wehry; Peter U Heuschmann; Matthias Endress; Karl Georg Haeusler Journal: J Neurol Date: 2021-10-31 Impact factor: 4.849