Researcher General Practice Care, General Practitioner
Publicatie
Publication date
Pattern of oral anticoagulants prescribing for atrial fibrillation in general practice: a study based on routine practice data from general practices in the Netherlands.
Kager, C.C.M., Horsselenberg, M., Korevaar, J.C., Wagner, C., Hek, K. Pattern of oral anticoagulants prescribing for atrial fibrillation in general practice: a study based on routine practice data from general practices in the Netherlands. BJGP Open: 2023, 7(1), p. Art. nr. BJGPO.2022.0179.
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Background
In the Dutch Atrial Fibrillation(AF) guideline for general practitioners (GPs) vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are seen as equivalent, while in cardiology there is a preference for DOACs.
Aim
To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in AF patients.
Design & setting
Observational study using routine practice data from 214 general practices, from 2017 until 2019.
Method
Patients aged 60 years or older diagnosed with AF, who had been prescribed an OAC in 2018 by their GP were included. A distinction was made between starters, who did not use OACs in 2017 and prevalent users. We determined whether patients switched between VKA and DOAC.
Results
12,516 AF patients were included. 476 patients (4%) started OAC in 2018; 12,040 patients were prevalent OAC users. When starting an OAC by GPs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used a VKA (60%). 1% of starters and 0.6% of prevalent users switched between OACs in 2018-2019 by a GP.
Conclusion
Dutch GPs predominantly start with DOACs in newly diagnosed AF patients. Prevalent patients predominantly use VKAs and switching from DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent International Normalised Ratio (INR) checks for VKA users.
In the Dutch Atrial Fibrillation(AF) guideline for general practitioners (GPs) vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are seen as equivalent, while in cardiology there is a preference for DOACs.
Aim
To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in AF patients.
Design & setting
Observational study using routine practice data from 214 general practices, from 2017 until 2019.
Method
Patients aged 60 years or older diagnosed with AF, who had been prescribed an OAC in 2018 by their GP were included. A distinction was made between starters, who did not use OACs in 2017 and prevalent users. We determined whether patients switched between VKA and DOAC.
Results
12,516 AF patients were included. 476 patients (4%) started OAC in 2018; 12,040 patients were prevalent OAC users. When starting an OAC by GPs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used a VKA (60%). 1% of starters and 0.6% of prevalent users switched between OACs in 2018-2019 by a GP.
Conclusion
Dutch GPs predominantly start with DOACs in newly diagnosed AF patients. Prevalent patients predominantly use VKAs and switching from DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent International Normalised Ratio (INR) checks for VKA users.
Background
In the Dutch Atrial Fibrillation(AF) guideline for general practitioners (GPs) vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are seen as equivalent, while in cardiology there is a preference for DOACs.
Aim
To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in AF patients.
Design & setting
Observational study using routine practice data from 214 general practices, from 2017 until 2019.
Method
Patients aged 60 years or older diagnosed with AF, who had been prescribed an OAC in 2018 by their GP were included. A distinction was made between starters, who did not use OACs in 2017 and prevalent users. We determined whether patients switched between VKA and DOAC.
Results
12,516 AF patients were included. 476 patients (4%) started OAC in 2018; 12,040 patients were prevalent OAC users. When starting an OAC by GPs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used a VKA (60%). 1% of starters and 0.6% of prevalent users switched between OACs in 2018-2019 by a GP.
Conclusion
Dutch GPs predominantly start with DOACs in newly diagnosed AF patients. Prevalent patients predominantly use VKAs and switching from DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent International Normalised Ratio (INR) checks for VKA users.
In the Dutch Atrial Fibrillation(AF) guideline for general practitioners (GPs) vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are seen as equivalent, while in cardiology there is a preference for DOACs.
Aim
To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in AF patients.
Design & setting
Observational study using routine practice data from 214 general practices, from 2017 until 2019.
Method
Patients aged 60 years or older diagnosed with AF, who had been prescribed an OAC in 2018 by their GP were included. A distinction was made between starters, who did not use OACs in 2017 and prevalent users. We determined whether patients switched between VKA and DOAC.
Results
12,516 AF patients were included. 476 patients (4%) started OAC in 2018; 12,040 patients were prevalent OAC users. When starting an OAC by GPs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used a VKA (60%). 1% of starters and 0.6% of prevalent users switched between OACs in 2018-2019 by a GP.
Conclusion
Dutch GPs predominantly start with DOACs in newly diagnosed AF patients. Prevalent patients predominantly use VKAs and switching from DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent International Normalised Ratio (INR) checks for VKA users.
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