The use of new oral anticoagulants in patients with atrial fibrillation in Scotland : a population-based drug utilisation study

Mueller, Tanja and Alvarez-Madrazo, Samantha and Robertson, Charles and Bennie, Marion (2016) The use of new oral anticoagulants in patients with atrial fibrillation in Scotland : a population-based drug utilisation study. Pharmacoepidemiology and Drug Safety, 25 (Supple). pp. 186-187. 318. ISSN 1053-8569

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Abstract

Background: Atrial fibrillation (AF) is a common arrhythmic disorder and a major risk factor for stroke. Anticoagulants are widely used as a preventative measure; in addition to warfarin, three new oral anticoagulants (NOACs) – dabigatran, rivaroxaban, and apixaban – have been introduced for this purpose in Scotland since 2008. Objectives: To examine the uptake and use of NOACs in patients with a diagnosis of AF, confirmed in secondary care, in Scotland. Methods: Patients with a diagnosis of AF who have been treated with NOACs between January 2009 and June 2014 have been identified using data from the Scottish Morbidity Records (SMR) linked to the Prescribing Information System (PIS). Yearly incidence and prevalence of NOAC use have been calculated based on mid-year population estimates; adherence to drug treatment has been analysed by calculating duration of treatment and number of days’ supply (first up to, but not including last refill), and medication refill adherence (MRA), defined as total days’ supply divided by total days of study participation. Results: Between January 2009 and June 2014, 5769 patients with a confirmed diagnosis of AF received at least one prescription for any NOAC. 53.7% of patients were male, and the mean age at time of first prescription was 74.8 years (SD 11.3). Prevalence of NOAC use increased from 0.2 patients/100,000 population in 2009 to 63.5 patients/100,000 population in 2013; incidence per 100,000 population in 2013 ranged from 7.6 (dabigatran) to 33.2 patients (rivaroxaban). Among patients treated exclusively with NOACs who received at least two prescriptions (n=2000), mean duration of treatment and mean days’ supply dispensed were 235.0 and 235.4 days, respectively (SD 206.3; 201.4); MRA was 100.4% (SD 42.2). Conclusions: The findings suggest that AF patients are increasingly prescribed NOACs, including a substantive number of patients previously treated with warfarin. Overall adherence to NOACs among AF patients in Scotland seems to be satisfactory, yet additional information regarding persistence to and discontinuation of treatment is needed for a better understanding of NOAC utilisation.