65 TRENDS IN PREVALENCE AND ANTITHROMBOTIC PRESCRIPTIONS IN AF What is new? · The prevalence of reported atrial fibrillation (AF) in the general population more than tripled, from 0.4% in 2008 to 1.4% in 2017. · In patients with new-onset AF, older age and concurrent presence of heart failure, diabetes, vascular disease and dementia were independently associated with a higher likelihood of vitamin K antagonist (VKA) rather than non-VKA oral anticoagulant prescription. · In 2017, approximately one in every four patients with a diagnosis of AF and a CHA2DS2-VASc score ≥2 did not receive prophylactic oral anticoagulant therapy. INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. AF patients are at greater risk of stroke and thromboembolism than patients without AF. On average, the stroke and thromboembolic risk in patients with AF is 2–3% per year, but this can be as high as 14% per year in untreated AF patients with multimorbidity, as summarised by the CHA2DS2-VASc risk model. 1 If the CHA 2DS2-VASc score is equal to or exceeds 2 points, the stroke risk is considered high enough to warrant chronic oral anticoagulant (OAC) therapy for stroke prevention.1,2 Still, there is uncertainty about this threshold.3,4 Such prophylactic OAC therapy can be categorised into vitamin K antagonists (VKA) and non-VKA OACs (NOAC). Although both VKAs and NOACs are effective in preventing stroke, they inherently also increase the bleeding risk.5–11 Patients prescribed NOACs have a lower risk of intracranial bleeding compared with those taking VKAs, but a higher risk of gastrointestinal haemorrhage (particularly in the elderly).11 Platelet inhibitors are no longer indicated for stroke prevention in AF,2 because they are far less effective in stroke risk reduction than OAC therapy (22% versus 64%), and they are (nearly) not effective at all in those over 75 years.12,13 Nevertheless, platelet inhibitors are sometimes prescribed, notably in patients with (presumable) contraindications for VKAs or NOACs or in patients unwilling to receive OAC therapy. In this changing AF landscape with changing treatment modalities, the question is how AF prevalence and the choices in prescription of OACs have developed over time. Therefore, the aim of this study was to describe trends in AF prevalence and patterns of antithrombotic therapy prescriptions in the community. Furthermore, we explored if certain patient characteristics are associated with selective OAC prescription (i.e. channelling). 5
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