A long-term analysis in the primary and secondary prevention in Atrial Fibrillation

Background: We aimed to investigate prescriptions for oral anticoagulants (OACs) in atrial fibrillation (AF) newly diagnosed patients (2009-2018). Analyzing both primary and secondary prevention, we also evaluated variables associated with OAC prescription. Methods: This study is based on data from the representative nationwide Disease Analyzer database (IQVIA). Patients with an initial AF diagnosis between 2009 and 2018 were selected and categorized as stroke or non-stroke, as well as according to their CHA 2 DS 2 -VASc score (<2 or ≥ 2). The prevalence of OAC use was calculated (2009-2018). We adopted multivariate logistic regression models to analyze differences. Results: The proportion of OAC therapy increased from 32.2% in 2009 to 56.9% in 2018 in stroke patients and from 26.6% to 48.9% in non-stroke patients with CHD 2 DS 2 -VASc scores ≥ 2. When comparing AF patients treated with OACs in 2016-2018 versus those in 2009-2011, we observed a slight increase in age, but a considerable increase in dementia. In 2016-2018 neither age nor dementia were associated with prescription of OAC in stroke patients. Furthermore, in stroke patients, OAC treatment was negatively associated with ischemic heart disease (IHD) (29.8% in treated versus 46.0% in non-treated patients, p<0.001). In non-stroke patients with CHA 2 DS 2 -VASc scores ≥ 2, OAC therapy was negatively associated with an age >80 years, peripheral artery disease, IHD, and dementia. Conclusion: A considerable increase in OAC-treated patients with CHA 2 DS 2 -VASc scores ≥ 2 was noted from 2009 to 2018. There is still a restrain considering OA in AF patients in primary prevention in elderly >80 years and those with dementia.