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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
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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
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Journal Article
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
2020
Overview
Administrative data were used to investigate changes in hospitalizations for atrial fibrillation (AF), AF-related stroke, and treatment patterns between 2012 and 2016.
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.
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‰.
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.
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Aged
/ Anticoagulants - administration & dosage
/ Antithrombins - administration & dosage
/ Atrial Fibrillation - complications
/ Atrial Fibrillation - economics
/ Atrial Fibrillation - epidemiology
/ Bleeding
/ Catchment Area, Health - statistics & numerical data
/ Chronic obstructive pulmonary disease
/ Codes
/ Costs
/ Diabetes
/ Factor Xa Inhibitors - administration & dosage
/ Factor Xa Inhibitors - economics
/ Female
/ Gastrointestinal Hemorrhage - chemically induced
/ Gastrointestinal Hemorrhage - epidemiology
/ Hemorrhage - chemically induced
/ Hospitalization - statistics & numerical data
/ Humans
/ Ischemia
/ Male
/ Patients
/ Platelet Aggregation Inhibitors - administration & dosage
/ Platelet Aggregation Inhibitors - economics
/ Stroke
/ Stroke - prevention & control
/ Tariffs
/ Trends
