Improving Guideline-Indicated Oral Anticoagulation Use in Atrial Fibrillation

According to a study in Jama Network Open, only about half of patients with atrial fibrillation with increased stroke risk are receiving the guideline-recommended oral anticoagulant (OAC). Dr. Sean D. Pokorny and colleagues evaluated if mailing educational materials to patients and their clinicians could improve the use of OACs. Compared to usual care, however, the educational intervention yielded “no clinically meaningful, numerical, or statistically significant difference in rates of OAC initiation,” the authors concluded.

The IMPACT-AFib (Implementation of a Randomized Controlled Trial to Improve Treatment With Oral Anticoagulants in Patients With Atrial Fibrillation) trial reviewed the US Food and Drug Administration’s Sentinel System database to identify patients with atrial fibrillation who met eligibility criteria, as well as their clinicians and outcomes. The primary endpoint was the proportion of patients with at least one OAC prescription dispensed, or at least four international normalized ratio test results within one year of the intervention.

Among the 47,333 total patients,

Mean (standard deviation [SD]) age was 77.9 (9.7) years
Mean CHA2DS2-VASc score was 4.5 (1.7)
22,404 (47.3%) patients had an ATRIA bleeding risk score of 5 or more
8,890 (18.8%) patients had a history of hospitalizations for bleeding

The researchers reported that, at one year, 2,328 of the 23,546 (9.9%) patients in the intervention group had initiated OAC compared to 2,330 of the 23,787 (9.8%) patients in the usual care control group (adjusted OR, 1.01; 95% CI, 0.95-1.07; P=.79).

Considering their results, the study’s authors proposed that, “more-intensive interventions are needed to try and address the public health issue of underuse of anticoagulation for stroke prevention among patients with AF.”