Temporal and geographical trends in anticoagulant therapy and catheter ablation for atrial fibrillation in Japan, 2014–2022

BACKGROUND: In the past decade, treatment of atrial fibrillation (AF) has dramatically changed. Geographical variations and associated factors influencing implementation of anticoagulant therapy and catheter ablation for AF have not been completely elucidated. This study aimed to investigate the temporal and geographical trends in AF treatment and factors associated with the changes in AF treatment in Japan. METHODS: In this retrospective observational study, the number of outpatients prescribed direct oral anticoagulants (DOACs), the daily warfarin dosage for outpatient care, and the number of patients who underwent catheter ablation procedures with transseptal puncture (CA-TSP) per 100,000 population across Japanese prefectures from 2014 to 2022 were analyzed using open data from the national database of universal healthcare insurance claims of Japan. The factors influencing the changes in AF treatment from 2014 to 2022 were further assessed. RESULTS: An increase in DOAC prescription and CA-TSP and a decrease in warfarin dosages were observed. It was estimated that over 1.2 % of the Japanese population was prescribed DOACs in 2022. The implementation of anticoagulant therapy and CA-TSP varies geographically. In prefectures with younger populations, the increase in DOAC prescriptions was smaller, the reduction in warfarin dosages was less, and the number of patients who underwent CA-TSP procedures was higher between 2014 and 2022. A higher number of arrhythmia specialists was significantly associated with higher rates of CA-TSP. However, population density and the gross domestic product per capita were not significantly associated with anticoagulant therapy or CA-TSP. CONCLUSIONS: A consistent increase in DOAC prescriptions and CA-TSP procedures, along with a decrease in warfarin prescriptions, was observed in Japan between 2014 and 2022. Geographic variations in anticoagulant therapy and CA-TSP in Japan were linked to age distribution. The prevalence of AF in Japan might be increasing more rapidly than anticipated.