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Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians.

Abstract：

BACKGROUND:Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. METHODS:Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. RESULTS:19,613 individuals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p<0.001) and thus had lower CHADS₂- (1.19±0.32 vs 1.99±0.47, p<0.001) and CHA₂DS₂VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p<0.001). Correspondingly, the percentage of Indigenous Australians with CHADS₂ ≥ 2 (39.6% vs 44.1%, p<0.001) and CHA₂DS₂VASc-scores ≥ 2 (62.9% vs 78.8%, p<0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1% and 68.9% of Indigenous and non-Indigenous Australians with CHADS₂ scores ≥2, and 76.3% and 71.3% with CHA₂DS₂VASc scores ≥2, were under-anticoagulated. Similarly, 27.4% and 24.1% of Indigenous and non-Indigenous Australians with CHADS₂ scores=0, and 24.0% and 16.7% with CHA₂DS₂VASc-scores=0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS₂- or CHA₂DS₂VASc-score (p=0.045 and p<0.001 respectively). CONCLUSION:Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Wong CX,Lee SW,Gan SW,Mahajan R,Rangnekar G,Pathak RK,Twomey D,Schultz C,Ganesan AN,Brooks AG,Roberts-Thomson KC,Brown A,Lau DH,Sanders P

doi

10.1016/j.ijcard.2015.03.064

subject

Has Abstract

pub_date

2015-07-15 00:00:00

pages

20-4

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(15)00302-2

journal_volume

191

pub_type

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Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians.