OAC treatment rates in AF patients improve but still far from ideal

The treatment scope of oral anticoagulants (OACs) remains poor despite increasing treatment rates among high-risk atrial fibrillation (AF) patients, which is primarily credited to the expanding direct oral anticoagulant (DOAC) use, reports an Israel study.

A team of investigators conducted a retrospective cohort study that included all adult members of Clalit Health Services, the largest healthcare provider in Israel, with newly diagnosed nonvalvular AF between January 2014 and December 2019 with CHA₂DS₂-VASc score ≥2. They calculated OAC treatment rates and used multivariate regression models to identify the predictors of OAC initiation.

A total of 46,531 patients were included in the study. The 3-month cumulative OAC treatment rates improved over the years: 46.9 percent (95 percent confidence interval [CI], 46.9‒47.7) during 2014‒2015, 54.9 percent (95 percent CI, 54.1‒55.6) during 2016‒2017, and 61.7 percent (95 percent CI, 60.9‒62.4) during 2018‒2019.

DOACs accounted for 51.3 percent of prescribed OACs in 2014‒2015. This increased to 95.1 percent during 2018‒2019.

Multivariate analyses revealed increased odds of OACs initiation among AF patients across the years and across higher socioeconomic classes. Initiation was more likely among females, Jews, statin users, and patients previously screened for colorectal cancer, but less likely among smokers and those with impaired renal function.

The chances of OAC treatment improved with higher CHA₂DS₂-VASc score and declined with higher HAS-BLED score.

“OACs are considered the mainstay in preventing stroke in AF,” the investigators said. “OAC treatment remains suboptimal among AF patients, even after the introduction of DOACs.”