Ten-year trends in the use of oral anticoagulants in Australian general
practice patients with atrial fibrillation
Abstract
Objective: Appropriate use of oral anticoagulants (OACs) reduces the
risk of stroke in patients with atrial fibrillation (AF). The study
characterised the prescribing of OACs in people with AF in the
Australian primary care setting over 10 years. Methods: We performed 10
sequential cross-sectional analyses of patients with a recorded
diagnosis of AF between 2009 and 2018 using nationally representative
general practice data from the NPS MedicineWise’s dataset,
MedicineInsight. The proportion of patients with AF who were prescribed
an OAC based on their stroke risk was examined. Results: The sample size
of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The
proportion who were prescribed an OAC increased from 39.5% (95% CI
38.6%-40.5%) in 2009 to 52.0% (95% CI 51.5%-52.4%) in 2018 (p for
trend <0.001). During this time, the proportion of patients
with AF and high stroke risk who were prescribed an OAC rose from 41.7%
(95% CI 40.7%-42.8%) to 55.2% (95% CI 54.7%-55.8%; p for trend
<0.001) with the direct-acting oral anticoagulants accounting
for over three-quarters of usage by 2018. There was substantial
variation in OAC prescribing according to stroke risk between general
practices. In 2018, the proportion of moderate to high stroke risk
patients who were prescribed an OAC was 38.6% (95% CI 37.2%-40.1%)
in the lowest practice site quintile and 65.6% (95% CI 64.5%-66.7%)
in the highest practice site quintile. Conclusions: Over the ten years,
OAC prescribing in high stroke risk patients with AF increased by
one-third.