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Uptake in antithrombotic treatment and its association with stroke incidence in atrial fibrillation: insights from a large German claims database

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Abstract

Background

Underuse of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) results in thousands of preventable strokes in Germany each year. This study aimed to assess changes in antithrombotic therapy in AF patients after increased use of direct oral anticoagulants (DOACs) in Germany and to evaluate whether the adoption of DOAC therapy was associated with changes in AF-related stroke and bleeding over time.

Methods

Analyses were carried out on a large claims-based dataset of 4 million health-insured Germans. The study population consisted of 601,261 prevalent AF patients between 2011 and 2016 who were assigned to one of the following four treatment groups: DOAC, VKA, antiplatelets or no antithrombotic treatment. Treatment patterns were descriptively analysed and represented by cohort and CHA2DS2-VASc score. Clinical outcomes before and after the adoption of DOAC therapy were assessed using Poisson regression models.

Results

Use of OAC increased from 42 to 61% between 2011 and 2016, mainly due to more frequent prescription of DOACs. However, some underuse of OAC therapy remained even in high risk AF patients. In parallel with the increased prescription rate of OAC, there was an overall 24% incidence reduction in stroke between 2011 and 2016 which was mainly driven by reductions in ischemic strokes. Over the same time period the risk for major bleeding remained unchanged.

Conclusion

Between 2011 and 2016, the use of guideline-conform antithrombotic therapy in Germany has significantly increased. This was associated with a significant decline in strokes without an increased incidence of bleeding complications.

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Acknowledgements

This study was sponsored by Bristol-Myers Squibb and Pfizer. Parts of the present publication have been presented at the European Society of Cardiology Congress 2018 as a poster presentation.

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Authors and Affiliations

  1. Division Clinical Electrophysiology, Department of Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany

    Stefan H. Hohnloser

  2. Pfizer Deutschland GmbH, Berlin, Germany

    Edin Basic

  3. Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany

    Michael Nabauer

Authors
  1. Stefan H. Hohnloser
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  2. Edin Basic
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Corresponding author

Correspondence to Stefan H. Hohnloser.

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Conflict of interest

Professor Hohnloser has served as a consultant for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo and Jansen. Professor Nabauer has received lecture fees from Bayer, BMS/Pfizer, Boehringer Ingelheim and Daiichi Sankyo. Dr. Basic is employee of Pfizer Deutschland GmbH. The authors have indicated that they have no other conflicts of interest regarding the content of this article.

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Hohnloser, S.H., Basic, E. & Nabauer, M. Uptake in antithrombotic treatment and its association with stroke incidence in atrial fibrillation: insights from a large German claims database. Clin Res Cardiol 108, 1042–1052 (2019). https://doi.org/10.1007/s00392-019-01437-7

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  • DOI: https://doi.org/10.1007/s00392-019-01437-7

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