Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study
Objective To describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).Methods Descriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagn...
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doaj-217bd2b4ba7348828ccb0c1cab95017b2021-08-07T12:30:32ZengBMJ Publishing GroupOpen Heart2053-36242021-08-018210.1136/openhrt-2021-001737Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort studyJonathan Mant0Catherine L Saunders1Jenny Lund2Duncan Edwards3Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UKPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UKPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UKObjective To describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).Methods Descriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results 42 290 patients (49% female), aged 65–74 (n=11 722), 75–84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65–74 years, from 54% to 86% in people aged 75–84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65–74, 75–84 and 85+ years, respectively.Conclusions Rates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years.https://openheart.bmj.com/content/8/2/e001737.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jonathan Mant Catherine L Saunders Jenny Lund Duncan Edwards |
spellingShingle |
Jonathan Mant Catherine L Saunders Jenny Lund Duncan Edwards Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study Open Heart |
author_facet |
Jonathan Mant Catherine L Saunders Jenny Lund Duncan Edwards |
author_sort |
Jonathan Mant |
title |
Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
title_short |
Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
title_full |
Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
title_fullStr |
Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
title_full_unstemmed |
Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
title_sort |
anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study |
publisher |
BMJ Publishing Group |
series |
Open Heart |
issn |
2053-3624 |
publishDate |
2021-08-01 |
description |
Objective To describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).Methods Descriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results 42 290 patients (49% female), aged 65–74 (n=11 722), 75–84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65–74 years, from 54% to 86% in people aged 75–84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65–74, 75–84 and 85+ years, respectively.Conclusions Rates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years. |
url |
https://openheart.bmj.com/content/8/2/e001737.full |
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