ACC 2016: Low use of oral anticoagulation in AF patients at risk for stroke

April 4, 2016 – Very young or old patients are even less likely to receive oral blood thinners.

A new study shows that only one in two patients with atrial fibrillation in the United States who should have received oral blood thinners under current guidelines were in fact dispensed these medications. Among these patients, those who were very young or very old had even lower treatment rates than average.

In addition, patients with this common type of heart arrhythmia who did receive these blood thinners, also known as oral anticoagulants (OACs), only had prescriptions filled for an average of one out of three days.

Stroke is a leading cause of death and disability, and one in five strokes are due to atrial fibrillation. OACs reduce the risk of stroke by 66 percent, but underuse of these medications – which include warfarin, rivaroxaban, apixaban and dabigatran – is a public health concern.

Carried out by the DCRI’s Sean Pokorney, MD, (pictured) and colleagues, the results of the study – an analysis of data from the U.S. Food and Drug Administration’s Mini-Sentinel pilot project for drug safety surveillance – were presented on Monday at the annual Scientific Sessions of the American College of Cardiology in Chicago.

The study was a needs assessment based on data from an unselected cross-section of patients, which identified a major gap in clinical practice. This ‘real-world’ evidence will help define and justify a future cluster randomized trial to increase the appropriate use of OACs, involving educational interventions for patients and physicians, with the goal of identifying barriers to prescribing and taking OACs.

“This low use of OACs in atrial fibrillation patients may result in preventable strokes, providing a strong rationale for a randomized trial to assess strategies to increase the appropriate use of this class of drugs,” said lead author Pokorney. “We’re optimistic about the feasibility of using the Mini-Sentinel infrastructure to facilitate patient recruitment and follow-up of participants in a randomized trial.”

The authors identified patients with two diagnoses of atrial fibrillation –  a criterion chosen to raise the likelihood that the diagnosis was correct – among 16.2 million patients between January 2006 and June 2014.  The data, from insurance claims databases at Aetna, Harvard Pilgrim and Humana, were used to calculate stroke risk. A unique feature of this research was the collaboration between the DCRI, Duke, Harvard, the FDA, and these three major national insurers.

In addition to Pokorney, DCRI authors included Richard Platt, MD, MSc; Emily O’Brien, PhD; Meena Rao, MD; Lesley Curtis, PhD; Pamela Tenaerts, MD, MBA; Hussein Al-Khalidi, PhD; and Christopher Granger, MD, FACC, FAHA.