Key result
In 2015, patients with atrial fibrillation and contraindications were prescribed anticoagulants at a similar rate to those without contraindications (67.2% vs 67.7%, p=0.595).
Why the study?
Does the presence of contraindications reduce the prescription of anticoagulants in patients with atrial fibrillation?
Cross-Sectional (n=166,136)
Yes
Does the presence of contraindications reduce the prescription of anticoagulants in patients with atrial fibrillation?
Absolute Event Rate: 67.2% vs 67.7%
p-value: p=0.595
The presence of recorded contraindications has little influence on the decision to prescribe anticoagulants for stroke prevention in UK patients with atrial fibrillation, raising potential patient safety concerns.
Similar rates despite contraindications raise caution for inappropriate prescribing; leaves open appropriateness and outcomes in real-world AF cohorts.
BACKGROUND: Underuse of anticoagulants in atrial fibrillation (AF) is an international problem, which has often been attributed to the presence of contraindications to treatment. No studies have assessed the influence of contraindications on anticoagulant prescribing in the UK. AIM: To determine the influence of contraindications on anticoagulant prescribing in patients with AF in the UK. DESIGN AND SETTING: Cross-sectional analysis of primary care data from 645 general practices contributing to The Health Improvement Network, a large UK database of electronic primary care records. METHOD: Twelve sequential cross-sectional analyses were carried out from 2004 to 2015. Patients with a diagnosis of AF aged ≥35 years and registered for at least 1 year were included. Outcome measure was prescription of anticoagulant medication. RESULTS: Over the 12 study years, the proportion of eligible patients with AF with contraindications who were prescribed anticoagulants increased from 40.1% (95% confidence interval [CI] = 38.3 to 41.9) to 67.2% (95% CI = 65.6 to 68.8), and the proportion of those without contraindications prescribed anticoagulants increased from 42.1% (95% CI = 41.6 to 42.6) to 67.7% (95% CI = 67.2 to 68.1). In patients with a recent history of major bleeding or aneurysm, prescribing rates increased from 44.3% (95% CI = 42.2 to 46.5) and 34.8% (95% CI = 29.4 to 40.6) in 2004 to 71.7% (95% CI = 69.9 to 73.5) and 63.2% (95% CI = 58.3 to 67.8) in 2015, respectively, comparable with rates in patients without contraindications. CONCLUSION: The presence or absence of recorded contraindications has little influence on the decision to prescribe anticoagulants for the prevention of stroke in patients with AF. The study analysis suggests that, nationally, 38 000 patients with AF with contraindications are treated with anticoagulants. This has implications for patient safety.
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Adderley et al. (2017) conducted a cross-sectional in Atrial fibrillation (n=166,136). Presence of contraindications to anticoagulants vs. Absence of contraindications to anticoagulants was evaluated on Prescription of anticoagulant medication in eligible patients (CHADS2 ≥1) (p=0.595). In 2015, patients with atrial fibrillation and contraindications were prescribed anticoagulants at a similar rate to those without contraindications (67.2% vs 67.7%, p=0.595).
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