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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Stroke prevention in atrial fibrillation in Germany. Situational analysis of treatment reality based on
Ulrike Mergenthaler1, Karel Kostev1, Sven Moosmang2
1IMS Health GmbH, Frankfurt am Main, Deutschland.
Insights
Optimizing anticoagulant therapy for atrial fibrillation (AF) patients is crucial. Adhering to guidelines can reduce strokes and bleeding risks, while also conserving healthcare resources.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Guideline-based anticoagulant therapy is recommended for atrial fibrillation (AF) patients to reduce stroke risk.
- Anticoagulants are a cornerstone in managing AF-related thromboembolic events.
- Optimizing therapy ensures patient safety and treatment efficacy.
Purpose of the Study:
- To analyze the utilization of oral anticoagulation in German AF patients.
- To assess adherence to guideline-based risk-adjusted therapy.
- To identify areas for improvement in anticoagulation management for AF.
Main Methods:
- Analysis of anonymized patient records from the IMS Health Disease Analyzer database (n=113,619).
- Observation period from November 2010 to October 2013.
- Extrapolation of findings to German general practitioner (GP) and cardiology practices.
Main Results:
- AF prevalence increased from 2.1 million in 2011 to 2.8 million in 2013.
- Vitamin K antagonists (VKAs) were commonly prescribed; factors like unstable INR and comorbidities influenced switching to non-vitamin K antagonist oral anticoagulants (NOACs).
- Significant proportions of patients with high stroke risk (CHA2DS2-VASc ≥ 2) were undertreated (17.3-36.5%), while some with low risk (CHA2DS2-VASc = 0) were unnecessarily treated (38.5%). An estimated 29,749 ischemic strokes in GP practices in 2013 could potentially be avoided.
Conclusions:
- Current risk-based anticoagulation in AF patients requires optimization.
- Adherence to guideline recommendations for OAC use can minimize bleeding risks and reduce ischemic strokes.
- Improved anticoagulation management can lead to better patient outcomes and resource allocation.
Background:
Guideline-based, risk-adjusted therapy with anticoagulants reduce thromboembolic stroke risk in patients with atrial fibrillation (AF).
Method:
This study analyzed use of oral anticoagulation in German AF-patients. Access to anonymized patient records was made via IMS Health Disease Analyzer database (sample size: 113,619 patients with ICD-10 Code I48.-; observation period: 11/2010-10/2013). Results were subsequently extrapolated to all general practitioners' (GPs) and cardiological practices in Germany.
Results:
In 2011 12-month AF-prevalence was extrapolated to 2.1 million patients (first diagnosed: n = 537.548). In 2012 AF-prevalence gone up to 2.2 million cases (first diagnosed: n = 537.548) and in 2013 to 2.8 million (first diagnosed: n = 636.571). Commonly prescribed oral anticoagulants (OAC) were vitamin K antagonists (VKA). Unstable INR setting, private health insurance, hospital admission, heart failure or hypertension increased probability of change from VKA to non-vitamin K antagonist oral anticoagulants (NOAC). 17.3-36.5% of patients with CHA2DS2-VASc-score ≥ 2 did not receive any thromboembolism prophylaxis; 38.5% with CHA2DS2-VASc-score = 0 received unnecessarily OACs. For 2013 a potential of 29.749 ischemic strokes in GP practices was calculated, which possibly can be avoided by thromboembolism prophylaxis according to guidelines.
Conclusions:
Risk-based anticoagulation showed requirements for optimization. Use of OACs, according to guideline recommendations, would minimize bleeding risks, reduce ischemic strokes and could release resources.
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