Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands
Background: In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) 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 a...
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| Format: | Article |
| Language: | English |
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Royal College of General Practitioners
2023-03-01
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| Series: | BJGP Open |
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| Online Access: | https://bjgpopen.org/content/7/1/BJGPO.2022.0179 |
| _version_ | 1797850929098129408 |
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| author | Catharina CM Kager Maaike Horsselenberg Joke C Korevaar Cordula Wagner Karin Hek |
| author_facet | Catharina CM Kager Maaike Horsselenberg Joke C Korevaar Cordula Wagner Karin Hek |
| author_sort | Catharina CM Kager |
| collection | DOAJ |
| description | Background: In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) 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 patients with AF. Design & setting: Observational study using routine practice data from 214 general practices, from 2017 until 2019. Method: Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs. Results: A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019. Conclusion: Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a 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. |
| first_indexed | 2024-04-09T19:08:27Z |
| format | Article |
| id | doaj.art-c2f7034c6bcd46f88bb2439e6266e8fc |
| institution | Directory Open Access Journal |
| issn | 2398-3795 |
| language | English |
| last_indexed | 2024-04-09T19:08:27Z |
| publishDate | 2023-03-01 |
| publisher | Royal College of General Practitioners |
| record_format | Article |
| series | BJGP Open |
| spelling | doaj.art-c2f7034c6bcd46f88bb2439e6266e8fc2023-04-07T07:53:59ZengRoyal College of General PractitionersBJGP Open2398-37952023-03-017110.3399/BJGPO.2022.0179Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The NetherlandsCatharina CM Kager0Maaike Horsselenberg1Joke C Korevaar2Cordula Wagner3Karin Hek4Netherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsNetherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsNetherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsNetherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsNetherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsBackground: In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) 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 patients with AF. Design & setting: Observational study using routine practice data from 214 general practices, from 2017 until 2019. Method: Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs. Results: A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019. Conclusion: Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a 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.https://bjgpopen.org/content/7/1/BJGPO.2022.0179anticoagulantsatrial fibrillationprescribing patterngeneral practicedirect-acting oral anticoagulantvitamin k antagonistprimary healthcare |
| spellingShingle | Catharina CM Kager Maaike Horsselenberg Joke C Korevaar Cordula Wagner Karin Hek Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands BJGP Open anticoagulants atrial fibrillation prescribing pattern general practice direct-acting oral anticoagulant vitamin k antagonist primary healthcare |
| title | Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands |
| title_full | Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands |
| title_fullStr | Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands |
| title_full_unstemmed | Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands |
| title_short | Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands |
| title_sort | pattern of oral anticoagulant prescribing for atrial fibrillation in general practice an observational study in the netherlands |
| topic | anticoagulants atrial fibrillation prescribing pattern general practice direct-acting oral anticoagulant vitamin k antagonist primary healthcare |
| url | https://bjgpopen.org/content/7/1/BJGPO.2022.0179 |
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