Four-year trends in oral anticoagulant use and declining rates of ischemic stroke among 194,030 atrial fibrillation patients drawn from a sample of 12 million people - 05/02/20
, Letizia Dondi a, Felicita Andreotti c, Antonella Pedrini a, Silvia Calabria a, Giulia Ronconi a, Carlo Piccinni a, Nello Martini aAbstract |
Background |
Administrative data were used to investigate changes in hospitalizations for atrial fibrillation (AF), AF-related stroke, and treatment patterns between 2012 and 2016.
Methods |
From the ‘Ricerca e Salute’ database, a population- and patient-based repository involving >12 million inhabitants and linking demographics, prescriptions, and hospital discharge records, all patients discharged alive with a diagnosis of AF between 2012 and 2015 were followed for 1 year.
Results |
A total of 194,030 AF patients were included. The number of AF cases increased ~10% over time, from 4.0 per 1,000 inhabitants in 2012 to 4.4 per 1,000 in 2015. At 1 year, hospitalizations for ischemic stroke decreased from 21.3 per 1,000 patients with AF in 2012-2013 to 14.7 per 1,000 in 2015-2016 (−31%, 95% CI −18 to −41). Over the same period, oral anticoagulant (OAC) use increased from 56.7% to 64.4% (+14%, 95% CI +8 to +26), vitamin K antagonist use decreased (from 55.9 to 36.7%; −34%, 95% CI −21 to −44), whereas direct OACs (DOACs) increased (from <1% in 2012 to 27.7% in 2015). Antiplatelet prescriptions fell from 42.6% in 2012 to 28.1% in 2015. Hospitalizations for major bleeds, mainly gastrointestinal, increased from 1.5‰ in 2012-2013 to 2.3‰ in 2015-2016, whereas hemorrhagic stroke admissions decreased from 6.5‰ to 4.1‰.
Conclusions |
There was a slight increase in the prevalence of AF between 2012 and 2015, whereas the overall use of antiplatelet agents decreased and that of OAC, particularly DOACs, increased. Over the same period, 1-year hospitalizations for ischemic stroke declined substantially, with a declining rate of hemorrhagic strokes.
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| ☆ | Competing interests: A. P. M. received grants for the participation in committees of studies supported by Bayer, Novartis, and Fresenius, outside the contents of this manuscript. F. A. reports speaker or consultancy fees from Amgen, Bayer, BMS-Pfizer, Boehringer Ingelheim. and Daiichi Sankyo, not related to the present work. The remaining authors have no conflicts to declare. |
| ☆☆ | Funding: This analysis of the ReS database was partially supported by Bayer Italy. |
| ☆☆☆ | Authors' contributions: All authors provided substantial contributions to data interpretation, drafting of the article, critical revision for important intellectual content, and final approval of the version to be submitted. |
Vol 220
P. 12-19 - Febbraio 2020 Ritorno al numero
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