Rates of nontreatment (2.0-51.1%) and undertreatment (10.0-45.1%) among patients with non-valvular atrial fibrillation remain high and are associated with preventable cardiovascular events and death.
Systematic Review
Does treatment with oral anticoagulants reduce stroke and mortality compared to nontreatment or undertreatment in patients with non-valvular atrial fibrillation and elevated stroke risk?
A significant proportion of high-risk patients with non-valvular atrial fibrillation remain untreated or undertreated with oral anticoagulants, leading to preventable cardiovascular events and death.
OBJECTIVE: Global treatment guidelines recommend treatment with oral anticoagulants (OACs) for patients with non-valvular atrial fibrillation (NVAF) and an elevated stroke risk. However, not all patients with NVAF and an elevated stroke risk receive guideline-recommended therapy. A literature review and synthesis of observational studies were undertaken to identify the body of evidence on untreated and undertreated NVAF and the association with clinical and economic outcomes. METHODS: An extensive search (1/2010-4/2020) of MEDLINE, the Cochrane Library, conference proceedings, and health technology assessments (HTAs) was conducted. Studies must have evaluated rates of nontreatment or undertreatment in NVAF. Nontreatment was defined as absence of OACs (but with possible antiplatelet treatment), while undertreatment was defined as treatment with only antiplatelet agents. RESULTS: Sixteen studies met our inclusion criteria. Rates of nontreatment for patients with elevated stroke risk ranged from 2.0-51.1%, while rates of undertreatment ranged from 10.0-45.1%. The clinical benefits of anticoagulation were reported in the evaluated studies with reductions in stroke and mortality outcomes observed among patients treated with anticoagulants compared to untreated or undertreated patients. Adverse events associated with all bleeding types (i.e. hemorrhagic stroke, major bleeding or gastrointestinal hemorrhaging) were found to be higher for warfarin patients compared to untreated patients in real-world practice. Healthcare resource utilization was found to be lower among patients highly-adherent to warfarin compared to untreated patients. CONCLUSIONS: Rates of nontreatment and undertreatment among NVAF patients remain high and are associated with preventable cardiovascular events and death. Strategies to increase rates of treatment may improve clinical outcomes.
Sussman et al. (Sat,) conducted a systematic review in Non-valvular atrial fibrillation (NVAF) and elevated stroke risk. Nontreatment or undertreatment vs. Oral anticoagulants (OACs) was evaluated on Rates of nontreatment or undertreatment. Rates of nontreatment (2.0-51.1%) and undertreatment (10.0-45.1%) among patients with non-valvular atrial fibrillation remain high and are associated with preventable cardiovascular events and death.