Abstract
BackgroundIt has been reported that oral anticoagulation (OAC) is underused among Chinese patients with non-valvular atrial fibrillation (NVAF). Non-vitamin K antagonist oral anticoagulants (NOAC) have been recommended by recent guidelines and have been covered since 2017 by the Chinese medical insurance; thus, the overall situation of anticoagulant therapy may change. The aim of this study was to explore the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province.MethodsThis was a multi-center, cross-sectional study that was conducted in seven hospitals from January to September in 2017. The demographic characteristics and medical history of the patients were collected by questionnaire and from the medical records. Multivariate logistic regression was used to identify factors associated with anticoagulant therapy.ResultsA total of 593 patients were included in the analysis. A total of 35.6% of the participants received OAC (11.1% NOAC and 24.5% warfarin). Of those patients with a high risk of stroke, 11.1% were on NOAC, 24.8% on warfarin, 30.6% on aspirin, and 33.6% were not on medication. Self-paying, duration of AF ≥5 years were negatively associated with anticoagulant therapy in all patients (OR 1.724, 95% CI 1.086~2.794; OR 1.471, 95% CI 1.006~2.149, respectively), whereas, permanent AF was positively associated with anticoagulant therapy (OR 0.424, 95% CI 0.215~0.839). Among patients with high risk of stroke, self-paying and increasing age were negatively associated with anticoagulant therapy (OR 2.305, 95% CI 1.186~4.478; OR 1.087, 95% CI 1.041~1.135, respectively).ConclusionsAnticoagulant therapy is positively associated with permanent AF and negatively associated with self-paying, duration of AF > 5 years. Furthermore, the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province does not appear optimistic. Therefore, further studies should focus on how to improve the rate of OAC use among NVAF patients. In addition, policy makers should pay attention to the economic situation of the patients with NVAF using NOAC.Trial registration2,017,029. Registered 20 March 2017 (retrospectively registered).
Highlights
It has been reported that oral anticoagulation (OAC) is underused among Chinese patients with nonvalvular atrial fibrillation (NVAF)
The majority of patients (87.2%) were older than 60 years and more than half of the patients had a primary school education or below. 56.3% of the patients had a duration of Atrial fibrillation (AF) which was less than 5 years; 72.8% of patients had a high risk of stroke; 10.5% had a high risk of bleeding
Multivariate logistic regression analysis indicated that self-paying, increasing age, duration of AF ≥5 years were negatively associated with anticoagulant therapy in all patients, whereas permanent AF was positively associated with anticoagulant therapy
Summary
It has been reported that oral anticoagulation (OAC) is underused among Chinese patients with nonvalvular atrial fibrillation (NVAF). The aim of this study was to explore the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province. With an increasingly aging population and the incidence of AF-related risk factors, this number is expected to rise. AF is an independent risk factor for stroke, and AF-related stroke accounts for 20% of all strokes [3, 4]. Apart from this, AF is independently associated with a 2-fold increased risk of all-cause mortality in women and a 1.5-fold increase in men [5,6,7], imposing a considerable medical burden on individuals and health care systems
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