Patient characteristics
Total number of patient in CONTENT in 2011 was
n = 145,461 (point-prevalence of AF on 31.12.2011: 1.51%), in 2014
n = 207,253 (point-prevalence of AF on 31.12.2014: 1.85%).In total, data of
n = 2642 patients from 43 general practices was obtained in this study. We included
n = 804 in Group A,
n = 755 in Group B and
n = 1083 in Group C. In two-sample comparison, presented in Table
1, groups A and B did not differ regarding sex or comorbidities, but group B was younger than group A (
p < 0.01). Number of patients > 75 years, contributing to CHA
2DS
2-VASc-Score twice, was 66.3% in group A (
n = 533) which was comparable to 61.9% in group B (
n = 467). 87.3% of patients in group A (
n = 702) and 84.8% of patients in group B (
n = 640) presented with CHA
2DS
2-VASc-Score ≥ 2, which indicated OAC at time of the study (p = n.s.).
Table 1
Patient characteristics comparing 2011 and 2014 independently
patients (n) | total | 804 | 755 | |
gender (%) | male | 374 (46.5%) | 388 (51.4%) | .06a |
female | 429 (53.4%) | 367 (48.6%) |
undetermined | 1 (0.1%) | 0 | |
age (years) | Median (IQR) | 79 (71–86) | 77 (70–83) | <.01b |
Min – Max | 19–99 | 18–103 |
< 65 | 92 (11.4%) | 118 (15.6%) |
65–74 | 179 (22.3%) | 170 (22.5%) |
≥75 | 533 (66.3%) | 467 (61.9%) |
additional diagnosis | at least 1 additional | 750 (93.3%) | 724 (95.9%) | .02a |
renal insufficiency | 54 (6.7%) | 55 (7.3%) | .66a |
coagulopathy | 13 (1.6%) | 17 (2.3%) | .36a |
intracranial bleeding | 8 (1.0%) | 6 (0.8%) | .68a |
epistaxis | 7 (0.9%) | 10 (1.3%) | .39a |
gastrointestinal bleeding | 15 (1.9%) | 12 (1.6%) | .68a |
stroke | 43 (5.3%) | 34 (4.5%) | .44a |
CHA2DS2-VASC: | 0 | 48 (6.0%) | 56 (7.4%) | .34a |
1 | 54 (6.7%) | 59 (7.8%) |
≥2 | 702 (87.3%) | 640 (84.8%) |
prescriptions (per year) | patients with at least 1 prescription | 684 (85.1%) | 677 (89.7%) | <.01a |
Md (IQR) | 12 (5–25) | 15 (6–24) | .31b |
Min - Max | 1–123 | 1–123 |
all patients | | | .02b |
Md (IQR) | 10 (2–22.8) | 13 (3–23) |
Min - Max | 0–123 | 0–123 |
OAC | VKA or NOAC | 186 (23.1%) | 323 (42.8%) | <.01a |
VKA | 182 (22.6%) | 188 (24.9%) | .29a |
Rivaroxaban | 0 (0.0%) | 121 (16.0%) | <.01a |
Dabigatran | 5 (0.6%) | 14 (1.9%) | .03a |
Apixaban | 0 (0.0%) | 10 (1.3%) | <.01c |
ASA (without additional OAC)d | 123 (15.3%) | 62 (8.2%) | <.01a |
consultation of cardiologist | 125 (15.5%) | 165 (21.9%) | <.01a |
Group C included n = 1083 patients (Table
2), of whom 51.9% were above 75 years in 2011 (
n = 562) and 64.4% in 2014 (
n = 697). Percentage of patients with CHA
2DS
2-VASc-Score ≥ 2 increased from 81.6% (
n = 884) to 83.8% (
n = 908,
p < .01). 91% of patients with diagnosed AF presented with at least one additional diagnosis, such as renal insufficiency (
n = 1003).
Table 2
Patient characteristics over time
patients (n) | total | 1083 | n/a |
gender (%) | male | 584 (53.9%) | n/a |
female | 470 (43.4%) |
undetermined | 29 (2.7%) |
age (years) | Median (IQR) | 75 (68–81) | 78 (71–84) | n/a |
Min – Max | 24–93 | 27–96 |
< 65 | 200 (18.5%) | 145 (13.4%) |
65–74 | 321 (29.6%) | 241 (22.3%) |
≥75 | 562 (51.9%) | 697 (64.4%) |
| additional diagnosis | patients With at least 1 | 1003 (92.6%) | 986 (91.0%) | .13a |
renal insufficiency | 61 (5.6%) | 65 (6.0%) | .77a |
coagulopathy | 17 (1.6%) | 17 (1.6%) | 1.0a |
intracranial bleeding | 4 (0.4%) | 5 (0.5%) | 1.0a |
epistaxis | 21 (1.9%) | 14 (1.3%) | .30a |
gastrointestinal bleeding | 13 (1.2%) | 17 (1.6%) | .59a |
stroke | 33 (3.0%) | 28 (2.6%) | .58a |
CHA2DS2-VASC: | 0 | 92 (8.5%) | 59 (5.4%) | <.01a |
1 | 100 (9.2%) | 87 (8.0%) |
≥2 | 884 (81.6) | 908 (83.8%) |
not computable | 7 (0.6%) | 29 (2.7%) | n/a |
prescriptions (per year) | total | 1056 (97.5%) | 1064 (98.2%) | n/a |
M (SD) | 19.4 (14.6) | 22.6 (16.5) | <.01b |
Min - Max | 1–118 | 1–115 |
all patients including those without prescription | | | <.01b |
M (SD) | 18.8 (14.8) | 22.0 (16.7) |
Min - Max | 0–118 | 0–115 |
OAC1 | VKA or NOAC | 382 (35.3%) | 600 (55.4%) | <.01a |
VKA | 373 (34.4%) | 387 (35.7%) | .41a |
Rivaroxaban | 3 (0.3%) | 181 (16.7%) | <.01a |
Dabigatran | 7 (0.6%) | 23 (2.1%) | <.01a |
Apixaban | none | 28 (2.6%) | n/c |
ASA (without additional OAC)2 | 136 (12.6%) | 97 (9.0%) | <.01a |
consultation of cardiologist | 245 (22.6%) | 262 (24.2%) | .32a |
Prescription of oral-anticoagulation
Two-sample comparison revealed an increase of prescription of OAC from 23.1% in 2011 (n = 186) to 42.8% in 2014 (n = 323, p < .01). Prescription-rate of VKA remained stable (22.6%, n = 182 and 24.9%, n = 188). Prescription of NOAC increased from 0.6% (n = 5) to 19.2% (n = 145, p < .01), whereas monotherapy with ASA decreased from 15.3% (n = 123) to 8.2% (n = 62, p < .01). The majority of patients with NOAC in 2014 received Rivaroxaban (84.8%, n = 121) compared to Dabigatran (9.6%, n = 14) and Apixaban (6.9%, n = 10). In 2014, cardiologists were involved more often compared with 2011 (15.5%, n = 125versus 21.9%, n = 165, p < .01).
In group C (involving longitudinal comparison, n = 1083), prescription of OAC increased from 35.3% (n = 382) to 55.4% (n = 600, p < .01) with similar prescription rate of VKA (34.4%, n = 373 and 35.7%, n = 387). Mean annual prescriptions per patient increased from 19.3 to 22.4 (p < .01). Prescription of NOAC in group C increased from 0.9 to 21.5% (p < .01). Prescription of ASA decreased over time (2011:12.6%, n = 136, 2014:9.0%, n = 97, p < .01). 11.9% (n = 44) of patients with VKA were switched to NOAC and in 19.9% OAC (n = 74) was discontinued completely. In 2011, 9 patients received a NOAC, of which 4 were stopped until 2014 and one patient was switched to VKA. 11.9% (n = 44) of patients with VKA were switched to NOAC. In 2014, majority of patients with AF and OAC received VKA: Group B: 56% n = 188/333, Group C: 62.5% n = 387/619.
In group C, 22.6–24.2% of patients attended a cardiologist but involvement of cardiologists did not significantly change over time (2011: 22.6%, 2014: 24.2%, p < .32). If cardiologists were involved, prescription of OAC increased over time from 51.6% in 2011 to 67.2% of patients in 2014 (p < .01).