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Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.

Publication ,  Journal Article
Navar, AM; Kolkailah, AA; Overton, R; Shah, NP; Rousseau, JF; Flaker, GC; Pignone, MP; Peterson, ED
Published in: J Am Heart Assoc
November 15, 2022

Background Among patients with nonvalvular atrial fibrillation (AF) and an elevated stroke risk, guidelines recommend direct oral anticoagulants (DOACs) over warfarin for stroke prevention. Changes in DOAC use over the past decade have not been well described. Methods and Results We evaluated trends in use of DOACs and warfarin from 2011 to 2020 among adults with AF and a CHA2DS2-VASc score ≥2 based on electronic health record data from 88 health systems in the United States contributing to Cerner Real World Data. The use of DOACs and warfarin was described over time, by age, sex, race, and ethnicity, and at the health-system level. We identified 436 864 patients with AF at risk for stroke (median age, 78 years; 52.1% men). From 2011 to 2020, overall anticoagulation rates increased from 56.3% to 64.7%, as DOAC use increased steadily (from 4.7% to 47.9%), while warfarin use declined (from 52.4% to 17.7%). DOAC uptake was similar across age, sex, and race and ethnicity groups but varied by health system. In 2020, the median health-system-level proportion of patients with AF on a DOAC was 49% (interquartile range, 40%-54%). Conclusions Over the past decade, anticoagulation rates for patients with AF have increased modestly as DOACs largely replaced warfarin, though significant gaps remain: One in 3 high-risk patients with AF is not on any anticoagulant. While DOAC adoption was generally consistent across major demographic groups, use between health systems remained highly variable, suggesting that provider and system factors influence DOAC uptake use more than patient-level factors.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 15, 2022

Volume

11

Issue

22

Start / End Page

e026723

Location

England

Related Subject Headings

  • Warfarin
  • United States
  • Stroke
  • Male
  • Humans
  • Female
  • Atrial Fibrillation
  • Anticoagulants
  • Aged
  • Administration, Oral
 

Citation

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Navar, A. M., Kolkailah, A. A., Overton, R., Shah, N. P., Rousseau, J. F., Flaker, G. C., … Peterson, E. D. (2022). Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020. J Am Heart Assoc, 11(22), e026723. https://doi.org/10.1161/JAHA.122.026723
Navar, Ann Marie, Ahmed A. Kolkailah, Robert Overton, Nishant P. Shah, Justin F. Rousseau, Greg C. Flaker, Michael P. Pignone, and Eric D. Peterson. “Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.J Am Heart Assoc 11, no. 22 (November 15, 2022): e026723. https://doi.org/10.1161/JAHA.122.026723.
Navar AM, Kolkailah AA, Overton R, Shah NP, Rousseau JF, Flaker GC, et al. Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020. J Am Heart Assoc. 2022 Nov 15;11(22):e026723.
Navar, Ann Marie, et al. “Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.J Am Heart Assoc, vol. 11, no. 22, Nov. 2022, p. e026723. Pubmed, doi:10.1161/JAHA.122.026723.
Navar AM, Kolkailah AA, Overton R, Shah NP, Rousseau JF, Flaker GC, Pignone MP, Peterson ED. Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020. J Am Heart Assoc. 2022 Nov 15;11(22):e026723.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 15, 2022

Volume

11

Issue

22

Start / End Page

e026723

Location

England

Related Subject Headings

  • Warfarin
  • United States
  • Stroke
  • Male
  • Humans
  • Female
  • Atrial Fibrillation
  • Anticoagulants
  • Aged
  • Administration, Oral