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Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)

Author

Listed:
  • M. Rosa Dalmau Llorca

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Co-senior authors: Dalmau Llorca MR, Aguilar Martín C, Gonçalves AQ and Fernández-Sáez. M. Rosa Dalmau Llorca is the Principal Investigator in this study.)

  • Carina Aguilar Martín

    (GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
    Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    Co-senior authors: Dalmau Llorca MR, Aguilar Martín C, Gonçalves AQ and Fernández-Sáez. M. Rosa Dalmau Llorca is the Principal Investigator in this study.)

  • Noèlia Carrasco-Querol

    (GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain)

  • Zojaina Hernández Rojas

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain)

  • Emma Forcadell Drago

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain)

  • Dolores Rodríguez Cumplido

    (GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 Barcelona, Spain)

  • Josep M. Pepió Vilaubí

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain)

  • Elisabet Castro Blanco

    (Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain)

  • Alessandra Q. Gonçalves

    (GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
    Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
    Co-senior authors: Dalmau Llorca MR, Aguilar Martín C, Gonçalves AQ and Fernández-Sáez. M. Rosa Dalmau Llorca is the Principal Investigator in this study.)

  • José Fernández-Sáez

    (Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain
    GAVINA Research Group, Tortosa, 43500 Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
    Co-senior authors: Dalmau Llorca MR, Aguilar Martín C, Gonçalves AQ and Fernández-Sáez. M. Rosa Dalmau Llorca is the Principal Investigator in this study.)

Abstract

Background : Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods : Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results : In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions : Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.

Suggested Citation

  • M. Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Josep M. Pepió Vilaubí & Elisabet Castro Blanco &, 2021. "Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)," IJERPH, MDPI, vol. 18(5), pages 1-16, February.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:5:p:2244-:d:505112
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    Citations

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    Cited by:

    1. Mª Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Elisabet Castro Blanco & Josep Mª Pepió Vilaubí &, 2021. "Gender and Socioeconomic Inequality in the Prescription of Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation in Primary Care in Catalonia (Fantas-TIC Study)," IJERPH, MDPI, vol. 18(20), pages 1-12, October.
    2. M. Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Elisabet Castro Blanco & Alessandra Queiroga Gonç, 2021. "Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study)," IJERPH, MDPI, vol. 18(11), pages 1-14, May.

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