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Published on: February 26, 2013
Inappropriate use of oral anticoagulants for patients with atrial fibrillation
Masaharu Akao1, Yeong-Hwa Chun, Masahiro Esato
1Department of Cardiology, National Hospital Organization Kyoto Medical Center.
Insights
Oral anticoagulants (OAC) are underused and overused in atrial fibrillation (AF) patients in Japan, despite guidelines. Real-world practice shows suboptimal OAC use, with similar stroke and bleeding risks for OAC and non-OAC users.
Area of Science:
- Cardiology
- Public Health
- Clinical Pharmacy
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia in the elderly, significantly increasing stroke risk.
- Oral anticoagulants (OAC) are recommended by evidence-based guidelines for stroke prevention in AF.
- Optimal OAC use is crucial for managing AF-related complications.
Purpose of the Study:
- To evaluate the real-world utilization and effectiveness of OAC in an urban Japanese population with AF.
- To identify discrepancies between clinical guidelines and actual OAC prescribing practices.
Main Methods:
- The Fushimi AF Registry prospectively collected data from 3,282 AF patients in a Japanese urban community.
- One-year follow-up data was analyzed for 2,914 patients.
- OAC usage, dosing, and clinical outcomes (stroke, major bleeding) were assessed.
Main Results:
- OAC, primarily warfarin, were prescribed to 53.1% of patients, with evidence of overuse in low-risk and underuse in high-risk individuals.
- Sub-therapeutic warfarin dosing was common, with only 54.4% of patients achieving the optimal therapeutic range.
- The 1-year incidence of stroke and major bleeding was comparable between OAC users and non-users.
Conclusions:
- The Fushimi AF Registry highlights suboptimal OAC management in Japanese AF patients.
- There is a significant gap between guideline recommendations and clinical practice regarding OAC use in AF.
- This discordance may contribute to the observed lack of benefit from OAC in this real-world cohort.
Background:
Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly, and increases the risk of stroke. Oral anticoagulants (OAC) are highly effective in preventing stroke, and there are evidence-based guidelines for the optimal use of OAC in patients with AF. METHODS AND RESULTS: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, a typical urban community in Japan with a total population of 283,000. Of the 3,282 patients enrolled by October 2012, 1-year follow-up was completed for 2,914 patients. OAC, mainly warfarin, were given to 1,546 patients (53.1%); overused for low-risk patients, and underused for patients at risk, based on the guidelines. Moreover, warfarin was sometimes given at a sub-therapeutic dose; only 54.4% of patients were within the optimal therapeutic range. The 1-year outcomes revealed that the incidences of both stroke and major bleeding were equivalent between patients taking OAC and those without; major clinical events were as follows: (OAC vs. non-OAC) stroke 2.7% vs. 2.8%, ischemic stroke 2.1% vs. 2.0% and major bleeding 1.4% vs. 1.5% (NS for all).
Conclusions:
The Fushimi AF Registry provides a unique snapshot of current AF management in an urban community in Japan. The present study reveals inappropriate use of OAC for patients with AF, indicating discordance between guideline recommendations and real-world clinical practice.
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