Related Experiment Video
Updated: Jun 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia
K Giskes1,2,3, N Lowres2,3, J Orchard3,1
1The University of Notre Dame, General Practice, Sydney, Australia.
Insights
Stroke risk management for atrial fibrillation (AF) patients improved, with more high-risk individuals on oral anticoagulants (OACs). However, many remain inadequately treated, highlighting the need for better stroke risk assessment and addressing bleeding concerns.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Atrial fibrillation (AF) significantly increases stroke risk.
- Recent guidelines emphasize CHA2DS2-VA score for risk assessment, prioritizing anticoagulation over antiplatelet agents (APAs) for high-risk patients, and recommending non-vitamin K oral anticoagulants (NOACs) as first-line therapy.
Purpose of the Study:
- To analyze trends in stroke risk management for high-risk non-valvular AF patients in Australia from 2011 to 2019.
- To evaluate the uptake of guideline-recommended therapies, including oral anticoagulants (OACs) and APAs.
Main Methods:
- Retrospective analysis of de-identified data from 164 Australian general practices.
- Identification of non-valvular AF patients and calculation of stroke risk using the CHA2DS2-VA score.
- Categorization of high-risk patients (CHA2DS2-VA ≥ 2) based on management: OACs, APAs only, or neither. Examination of prescribing trends and multivariate analysis of factors influencing OAC therapy.
Main Results:
- The study included 8696 AF patients, with 85.8% identified as high-risk.
- Management shifted towards OACs, increasing from 56.7% in 2011 to 73.7% in 2019, while APA use decreased from 31.1% to 14.0%.
- Despite improvements, 26.3% of high-risk patients were inadequately anticoagulated by 2019. Patients with higher stroke risk comorbidities were more likely to receive OACs.
Conclusions:
- Stroke risk management in AF patients has improved, with increased OAC use aligning with guidelines.
- A significant proportion of high-risk patients remain undertreated, indicating a need for enhanced clinical stroke risk assessment.
- Addressing practitioner concerns regarding bleeding risk is crucial for optimizing anticoagulation strategies in high-risk AF patients.
Background:
Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 2016-2018 advised that: 1. Stroke risk be estimated using the CHA2DS2-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants.
Aim:
To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011-2019.
Method:
De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA2DS2-VA score. High risk patients (i.e. CHA2DS2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management.
Results:
Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy.
Conclusions:
Stroke risk management among patients with AF has improved between 2011-2019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients.
More Related Videos
Related Concept Videos
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:14Decreased pulse rate
There are specific risk factors that can elevate the likelihood of developing bradycardia. Advanced age is a significant factor, with...
01:17Increased pulse rate
Many factors can elevate the risk of developing tachycardia. These include advanced age, a family history of arrhythmias, and an...