Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)

M. Rosa Dalmau Llorca, Carina Aguilar Martín, Noèlia Carrasco-Querol, Zojaina Hernández Rojas, Emma Forcadell Drago, Dolores Rodríguez Cumplido, Josep M. Pepió Vilaubí, Elisabet Castro Blanco, Alessandra Q. Gonçalves and José Fernández-Sáez
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M. Rosa Dalmau Llorca: Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
Carina Aguilar Martín: GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
Noèlia Carrasco-Querol: GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
Zojaina Hernández Rojas: Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
Emma Forcadell Drago: Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
Dolores Rodríguez Cumplido: GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
Josep M. Pepió Vilaubí: Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
Elisabet Castro Blanco: Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain
Alessandra Q. Gonçalves: GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
José Fernández-Sáez: Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain

IJERPH, 2021, vol. 18, issue 5, 1-16

Abstract: Background : Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods : Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results : In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions : Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.

Keywords: atrial fibrillation; direct oral anticoagulants; renal function; time in therapeutic range; vitamin K antagonists (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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