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Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study.

Accepted version
Peer-reviewed

Type

Article

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Authors

Saunders, Catherine L 
Edwards, Duncan 
Mant, Jonathan 

Abstract

OBJECTIVE: To describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF). METHODS: Descriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported. RESULTS: 42 290 patients (49% female), aged 65-74 (n=11 722), 75-84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65-74 years, from 54% to 86% in people aged 75-84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65-74, 75-84 and 85+ years, respectively. CONCLUSIONS: Rates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years.

Description

Keywords

anticoagulation, atrial fibrillation, epidemiology, Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Blood Coagulation, Drug Prescriptions, England, Female, Follow-Up Studies, Humans, Incidence, Male, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Thromboembolism, Time Factors

Journal Title

Open Heart

Conference Name

Journal ISSN

2053-3624
2053-3624

Volume Title

8

Publisher

BMJ

Rights

All rights reserved
Sponsorship
National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough Clinical Commissioning Group (CCG)) (PGfAR RP-PG-0217-20007)