Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia between 2011–2019

作者：Katrina Giskes, Nicole Lowres, J. Orchard, Karice Hyun, C. Hespe, Ben Freedman · 发表于：IJC Heart & Vasculature · 年份：2024 · DOI：10.1016/j.ijcha.2024.101443 · 被引用次数：6 · 研究领域：Atrial Fibrillation Management and Outcomes、Antiplatelet Therapy and Cardiovascular Diseases、Venous Thromboembolism Diagnosis and Management

Background: -VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants. Aim: To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011-2019. Method: 2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management. Results: Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy. Conclusions: Stroke risk management among patients with AF has improved between 2011-2019, however there is still scope for further g...