Key result
Median OAC use in AF stands at ~51%, with high heterogeneity driven by clinical setting.
Why the study?
Diverse estimates of guideline-based oral anticoagulant treatment uptake and treatment gaps in atrial fibrillation patients have been reported, requiring systematic evaluation.
Systematic Review
Yes
There is significant global variability and a substantial treatment gap in oral anticoagulant use for atrial fibrillation, with uptake heavily influenced by geographic region, study design, and treating physician specialty.
Substantial underuse of oral anticoagulants persists in atrial fibrillation; confirms implementation gaps and supports targeted strategies to address heterogeneity.
Guidelines endorse long-term oral anticoagulation (OAC) for stroke prophylaxis in patients with atrial fibrillation (AF) and additional stroke risk factors. However, diverse estimates of guideline based OAC treatment are reported. The objective was to provide insight into the variability seen in estimates of OAC treatment uptake and treatment gaps in clinical practice. A systematic review was conducted following Cochrane methodology, using comprehensive search terms for AF and anticoagulation. MEDLINE and EMBASE databases (January 2006–2016) were searched, and prospective and retrospective observational studies reporting OAC use included. Study data and patient characteristics were extracted, OAC rates pooled by study factors, and meta-regression analysis conducted to identify factors associated with OAC uptake. Of 8861 records screened, 155 eligible datasets from 147 studies were identified [median (25th, 75th percentiles) 2259 (595, 10,240) patients, mean age 73.8 ± 7.1 years]. The majority of studies included AF patients with CHA2DS2-VASc >1 [median proportion (25th, 75th percentile) 0.92 (0.83, 1.00)]. OAC use varied across studies [median proportion (25th, 75th percentile) 51.2% (36.7%, 64.7%)] with high heterogeneity (I2 = 100.0%). In the meta-regression analysis [coefficient, p], prospective study design (0.093, p = 0.008), general practitioner treating physician (0.105, p = 0.001) and data collection after 2013 (0.072, p = 0.070) were associated with higher OAC use. Consecutive enrollment (−0.075, p = 0.008) and Asian region (−0.181, p < 0.001) were associated with lower OAC use. Study factors, geographical and treatment settings are associated with estimates of OAC use and are important considerations for researchers and policy makers to appropriately interpret reported anticoagulation treatment rates. Consideration of these factors may help to more effectively measure interventions, and design studies to improve anticoagulation uptake.
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Paquette et al. (2021) conducted a systematic review in Atrial fibrillation. Oral anticoagulation (OAC) was evaluated on Proportion of oral anticoagulant use. In a systematic review of 147 studies, the median proportion of oral anticoagulant use in patients with atrial fibrillation was 51.2%, with high heterogeneity driven by study design and clinical setting.
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