Abstract
BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilization in the NOAC era.MethodA cross-sectional study using nationwide claims data was conducted. Elderly patients with NVAF at an increased risk of stroke were selected as candidates for OAC therapy before the index date (July 1, 2018). The status of anticoagulant utilization on the index date and factors influencing the use of anticoagulants was investigated in these patients.ResultsOf the 11,056 patients with NVAF who were eligible for OAC therapy, 7238 (65.5%) were receiving OAC on the index date, and 6302 (87.1%) were receiving NOACs. Patients aged ≥ 75 years had higher anticoagulant utilization than those aged 65–69 years. Among comorbid diseases, while hypertension was the most influential positive factor (odds ratio [OR] = 1.644; confidence interval [CI] = 1.445–1.869) in OAC utilization, severe renal disease was the most influential negative factor (OR = 0.289; CI = 0.200–0.416). Aspirin use had a significantly low OR (OR = 0.097; CI = 0.085–0.110) of anticoagulant use. OAC use was approximately 1.5 times higher in patients with persistent or permanent AF than in those with paroxysmal AF.ConclusionApproximately one-third of patients who are recommended anticoagulation therapy do not take OACs, even though the use of NOACs has become more common. It should be widely recognized that aspirin cannot be an alternative to OACs, and anticoagulant therapy should be actively implemented.
Highlights
The prevalence of atrial fibrillation (AF) is rising worldwide due to an aging population and advances in diagnostic technology [1, 2]
Of the 11,056 patients with nonvalvular atrial fibrillation (NVAF) who were eligible for oral anticoagulant (OAC) therapy, 7238 (65.5%) were receiving OAC on the index date, and 6302 (87.1%) were receiving Non-vitamin K antagonist oral anticoagulants (NOACs)
It should be widely recognized that aspirin cannot be an alternative to OACs, and anticoagulant therapy should be actively implemented
Summary
The prevalence of atrial fibrillation (AF) is rising worldwide due to an aging population and advances in diagnostic technology [1, 2]. The underutilization of anticoagulation therapy in patients with AF has been recognized as a global health problem [11,12,13,14]. OAC therapy for patients with AF has been limited to warfarin for a long time, and insufficient OAC option has been evaluated as a risk factor for OAC underutilization [15]. Since the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) in the 2010s, a range of OACs have become available for patients with AF. Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilization in the NOAC era
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