Sex and Gender Differences in Thromboprophylactic Treatment of Patients With Atrial Fibrillation After the Introduction of Non–Vitamin K Oral Anticoagulants

https://doi.org/10.1016/j.amjcard.2017.07.002Get rights and content

To examine sex differences in thromboprophylaxis in patients with atrial fibrillation before and after the introduction of non–vitamin K oral anticoagulants, we performed a cross-sectional registry study based on anonymized individual-level patient data of all individuals with a diagnosis of nonvalvular atrial fibrillation (International Classification of Diseases, Tenth Revision code I48) in the region of Stockholm, Sweden (2.2 million inhabitants), in 2011 and 2015, respectively. Thromboprophylaxis improved considerably during the period. During 2007 to 2011, 23,198 men and 18,504 women had an atrial fibrillation diagnosis. In 2011, more men than women (53% men vs 48% women) received oral anticoagulants (almost exclusively warfarin) and more women received aspirin only (35% women vs 30% men), whereas there was no sex difference for no thromboprophylaxis (17%). During 2011 to 2015, 27,237 men and 20,461 women had a diagnosis of atrial fibrillation. Compared with the earlier time period, a higher proportion used oral anticoagulants (71% women vs 70% men), but fewer women ≥80 years received anticoagulants (67% women vs 72% men), more women received aspirin (15% women vs 13% men), and fewer women had no thromboprophylaxis (15% women vs 17% men). Patients with co-morbidities potentially complicating oral anticoagulant use used more oral anticoagulant in 2015 compared with 2011. The sex differences observed in 2011 with fewer women using oral anticoagulants had disappeared in 2015 except in women 80 years and older and in patients with complicated co-morbidity.

Section snippets

Methods

This was a cross-sectional study based on individual-level patient data from the Stockholm regional health-care data warehouse (Vårdanalysdatabasen).6 It contains encrypted, anonymized data on patient age, sex, diagnoses, procedures, hospitalizations, prescription claims, and consultations including primary, secondary, and specialist ambulatory care for all individuals in the region of Stockholm, Sweden (2.2 million inhabitants). All residents in the Stockholm region with a diagnosis of atrial

Results

A total of 23,198 men and 18,504 women were diagnosed with nonvalvular atrial fibrillation by any health-care provider in the region during 2007 to 2011 (Figure 1). This corresponds to a prevalence of 2.2% for men and 1.8% for women regardless of age in 2011. By 2015, the number of individuals with diagnosis of atrial fibrillation had increased somewhat more for men to 27,237 compared with 20,461 for women, corresponding to a prevalence of 2.5% and 1.8%, respectively. Demographic

Discussion

Between 2011 and 2015, the number of patients with atrial fibrillation in Stockholm and their use of anticoagulant treatment increased substantially, from 53% in men and 48% in women to 70% regardless of the risk score in both sexes and to 75% in those with a CHA2DS2-VASc score ≥2. The previous sex difference had disappeared, and more patients with complicating co-morbidities were treated in 2015. These changes occurred following the introduction of NOACs and the replacement of CHADS2 by the CHA

Disclosures

The authors have no conflicts of interest to disclose.

References (30)

  • Statistics Sweden

    Population by region, marital status, age and sex

    (2016)
  • G.D. Barnes et al.

    National trends in ambulatory oral anticoagulant use

    Am J Med

    (2015)
  • J.D. Brown et al.

    A comparison of oral anticoagulant use for atrial fibrillation in the pre- and post-DOAC eras

    Drugs Aging

    (2016)
  • J.I. Weitz et al.

    Trends in prescribing oral anticoagulants in Canada, 2008–2014

    Clin Ther

    (2015)
  • B. Wettermark et al.

    Secondary prevention in a large stroke population: a study of patients' purchase of recommended drugs

    Stroke

    (2008)
  • Cited by (22)

    • Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases

      2021, American Journal of Medicine
      Citation Excerpt :

      Improving the accuracy of atrial fibrillation and all risk-factor diagnoses has importance related to quality-improvement projects to improve anticoagulant use33,43 and for future projects using databases to predict atrial fibrillation for further screening and interventions.44-51 We noted no sex difference in appropriate anticoagulant use in patients, similar to some other studies.52,53 Loikas et al52 noted that anticoagulant use in women improved and was similar to men by 2015, compared with a lower anticoagulant use in women in 2011.

    • Atrial Fibrillation

      2021, Sex Differences in Cardiac Diseases: Pathophysiology, Presentation, Diagnosis and Management
    • An audit & feedback intervention for improved anticoagulant use in patients with atrial fibrillation in primary care

      2020, International Journal of Cardiology
      Citation Excerpt :

      This is in line with a previous Swedish study from 2017 [23]. In that study men were more often dispensed anticoagulants in 2011, but in 2015 the sex differences only remained in the oldest age group (80 years and older) [23]. Women in intervention centers were more likely than women in control centers to be dispensed anticoagulants twice after the intervention.

    • Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: A systematic review and meta-analysis of 993,600 patients

      2018, International Journal of Cardiology
      Citation Excerpt :

      The adherence of clinicians to guideline recommendations for OAC therapy is associated with a reduction in all-cause death risk [69, 70]. These data underline once more the benefits of OAC in AF patients regardless of sex, yet a lower OAC prescription rate is constantly reported amongst female AF patients [71–73]. Interestingly, there was evidence of an increased risk of CV death for female AF patients in population cohort studies, while an increased risk for CV death in male AF patients is present in RCTs.

    • Atrial Fibrillation in Women: from Epidemiology to Treatment

      2022, Current Cardiovascular Risk Reports
    View all citing articles on Scopus

    See page 1306 for disclosure information.

    Funding: The study was supported by the Stockholm County Council (ALF project grant number LS 2015-0630), the Erika Lederhausen foundation, Center for Gender Medicine, Karolinska Institutet, the Swedish Association of Local Authorities and Regions (SALAR, SKL 08/2254), and by the Swedish Heart-Lung Foundation.

    Location: Stockholm, Sweden.

    View full text