Related Experiment Video
Updated: Mar 24, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Antithrombotic therapy in patients with non-valvular atrial fibrillation in Southern Sweden: A population-based
Natalia Mochalina1, Anna Jöud2, Maj Carlsson3
1Department of Cardiology, Skåne University Hospital, Malmö S-20502, Sweden.
Insights
Oral anticoagulant use in atrial fibrillation (AF) patients improved, but undertreatment persists, especially in younger women and the elderly. Overtreatment also occurred in low-risk patients, indicating a need for targeted interventions.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Oral anticoagulants are guideline-recommended for atrial fibrillation (AF) patients with moderate-to-high stroke risk.
- Previous studies highlight the importance of appropriate antithrombotic therapy in AF management.
Purpose of the Study:
- To assess trends in oral anticoagulant prescription patterns for non-valvular AF patients.
- To evaluate guideline adherence and identify undertreatment and overtreatment in AF patients.
- To examine demographic and clinical factors influencing antithrombotic therapy choices.
Main Methods:
- A population-based register study included 13,837 incident non-valvular AF patients diagnosed between 2011-2014 in Skåne County, Sweden.
- Prescription data for direct-acting oral anticoagulants (DOACs), warfarin, and acetylsalicylic acid (ASA) were analyzed.
- Outcomes were assessed based on CHA2DS2-VASc scores to evaluate stroke risk and guideline adherence.
Main Results:
- Guideline adherence for oral anticoagulant use in AF patients increased from 47.6% in 2011 to 66.1% in 2014.
- Undertreatment decreased, with ASA use declining and DOAC uptake rising significantly in high-stroke-risk patients (CHA2DS2-VASc score ≥ 2).
- Significant undertreatment persisted in women under 65 and patients over 84. Overtreatment was noted in low-stroke-risk individuals.
Conclusions:
- Despite improved guideline adherence, antithrombotic therapy use in AF patients remains suboptimal.
- Targeted interventions are crucial for specific subgroups, including young women, the elderly, and low-stroke-risk patients.
- Further efforts are needed to optimize antithrombotic prescribing practices in diverse clinical settings for AF patients.
Introduction:
Oral anticoagulants in patients with atrial fibrillation (AF) with moderate-to-high stroke risk are strongly recommended by the current guidelines.
Materials And Methods:
Population-based register study of all 13,837 patients with incident non-valvular AF diagnosed during 2011-2014 in primary and secondary care (including all in- and outpatient visits) in Skåne County, Sweden. The outcome was the prescription of direct-acting oral anticoagulants (DOAC), warfarin or acetylsalicylic acid (ASA).
Results And Conclusion:
Guideline adherence increased from 47.6% in 2011 to 66.1% in 2014, mostly due to decrease in undertreatment. In patients with CHA2DS2-VASc score ≥ 2, ASA uptake decreased from 29.9% to 14.7% and DOAC uptake increased from 2.1% to 25.1%. The use of ASA was more common among elderly and with increasing stroke- and bleeding risk. Overall, 47.4% of patients with CHA2DS2-VASc score ≥ 2 did not receive oral anticoagulants. Undertreatment was particularly common in women < 65 years (55.8%) and in patients > 84 years (65.3% in women and 62% in men). Overtreatment of patients at low stroke risk was 35.9% in men and 36.4% in women. Provider speciality affected the choice of treatment only to a minor degree. Despite increasing guideline adherence, there is a suboptimal use of antithrombotic therapy in a large proportion of AF patients diagnosed in different clinical settings. Efforts to further improve guideline adherence should particularly be targeted on women < 65 years, elderly > 84 years and patients at low stroke risk.
