Abstract
Patients with Type 2 diabetes mellitus (T2DM) have an increased risk of atrial fibrillation (AF). The current study aimed to investigate the prevalence and treatment of AF in patients with T2DM, assess the impact of direct oral anticoagulants (DOACs) introduction on oral anticoagulant (OACs) prescribing rates, and factors associated with OAC initiations in patients with T2DM and AF. The Health Improvement Network (THIN) database (2001–2016), was used to examine the annual prevalence and treatment of AF in T2DM. The impact of DOACs introduction on OAC prescribing rates were investigated using interrupted time series analysis (ITS). Factors associated with OAC initiations were also identified using multivariate logistic regression. The prevalence of AF increased from 2.7 [95% confidence intervals (CI) 2.5–2.8] in 2001 to 5.0 (4.9–5.1) in 2016 per 100 persons. OACs prescribing within 30-days of AF diagnosis increased from 21.5% in 2001 to 56.8% in 2016. ITS analysis showed that OAC prescribing increased after DOAC introduction (P < 0.001), however, no immediate change was observed (P = 0.29). T2DM patients with AF, aged 60–79, male gender and BMI ≥ 25 were more likely to receive OAC, adjusted OR 1.3 (1.2–1.5) for aged 60–79, 1.3 (1.2–1.4) for male gender and 2.0 (1.9–2.2) for BMI ≥ 25, respectively. This study highlighted an increase in prevalence of AF in patients with T2DM during the study period. Further studies are warranted to investigate factors contributing to the underuse of OAC in patients with T2DM and AF.
Highlights
Patients with atrial fibrillation (AF) were mainly treated with warfarin for the prevention of stroke; studies have reported under prescribing with these medications[5]
The key findings were: 1) the prevalence of AF in patients with Type 2 diabetes mellitus (T2DM) has increased from 2001 to 2016, 2) the proportion of patients with T2DM who were initiated on an oral anticoagulants (OAC) after AF diagnosis increased between 2001 and 2016, 3) the rate of OAC initiation after the introduction of direct oral anticoagulants (DOACs) into the market increased, and 4) our study demonstrated that age ≥ 75 years, previous bleeding or stroke/TIA and history of chronic kidney disease (CKD), were strong predictors for DOACs initiation
We found that the rate of OAC initiation after the introduction of DOACs increased significantly, this change was not immediate
Summary
Patients with AF were mainly treated with warfarin for the prevention of stroke; studies have reported under prescribing with these medications[5]. In the last 15 years, important changes have occurred in the management of AF This included the introduction of direct oral anticoagulants (DOACs) and the adoption of CHA2DS2-VASc scores, which includes diabetes as one of the important risk factors[6]. Previous studies that examined the prevalence and treatment of AF among patients with T2DM are limited. The objectives of this study were (i) to examine the trends of the prevalence of AF in patients with T2DM from 2001 to 2016; (ii) to investigate the proportions of patients with T2DM who were initiated oral anticoagulants (OAC) on/or after AF diagnosis, and to assess the impact on OAC prescribing rates after the introduction of direct oral anticoagulants (DOACs), and (iii) to investigate factors associated with the initiation of OAC in patients with T2DM and AF
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