P386Factors associated with the prescription practices of non-vitamin K antagonists in non valvular atrial fibrillation in daily clinical practice

Abstract

Background: Most recent studies have shown the relative safety, efficacy and convenience of the novel oral anticoagulants(NOACs) over vitamin K antagonists(VKAs) for stroke prevention in patients with non-valvular atrial fibrillation(NVAF) . However, data regarding their comparative preference in daily clinical practice are currently lacking. Purpose(s): To investigate the factors and the clinical characteristics of NVAF patients which contribute towards a significant underprescription or preference of NOACs in a "real-world" contemporary observational dataset. Method(s): We studied consecutive patients who were hospitalized to the cardiology department of a tertiary hospital with any diagnosis and coexisting NVAF. Comparisons regarding the type of the oral anticoagulant(OAC) therapy were made between patients who were eligible for NOACs. Result(s): A total of 741 NVAF patients were enrolled between December 2015-June 2017. OACs were prescribed at discharge in 580(78%) patients. 517(70%) were eligible for NOACs (no contraindications), of whom 329(64%) and 188(36%) received NOACs and VKAs, respectively. Relative hesitancy in selecting NOACs, in favor of VKAs, was observed at patients with very poor educational level(VPEL) [not VPEL(66%) vs VPEL(49%), p=0.014], history of bleeding while under OAC therapy [no bleeding(70%) vs bleeding(52%), p<0.001], unachieved therapeutic INR in the past(ThINRp) [not ThINRp(30%) vs ThINRp(16%)], symptomatic AF(SAF) [no SAF(68%) vs SAF(59%)], chronic AF(CAF) [no CAF(73%) vs CAF(54%)], high risk of bleeding [HASBLED(67%) vs HASBLED 3(44%)] and left atrial enlargement(LAE) [no LAE(68%) vs LAE(50%), p=0.048]. Comorbidities such as vascular disease(VD) [no VD(69%) vs VD(57%), p=0.004], chronic kidney disease(CCD) [no CCD(67%) vs CCD(40%), p<0.001], coronary artery disease(CAD) [no CAD(74%) vs CAD(51%), p<0.001], heart failure(HF) [no HF(75%) vs HF(54%), p<0.001] and coexistence of devices such as pacemaker (PM) [no PM(65%) vs PM(46%), p=0.025] and implantable cardioverter defibrillator(ICD) [no ICD(65%) vs ICD(30%)] are associated with underprescription of NOACs. On the other hand, NOACs were preferentially prescribed in patients with hypertrophic cardiomyopathy(HCM) [no HCM(63%) vs HCM(100%), p=0.016], atrial flutter(AFL) [no AFL(62%) vs AFL(93%), p=0.014], first diagnosed AF(fdAF) [no fdAF(60%) vs fdAF(78%), p=0.002] and palpitations(palp) as their main symptom at admission [no palp(60%) vs palp(79%), p<0.001]. Conclusion(s): In the real-world the preference for prescribing NOACs in NVAF patients eligible for them is determined by several clinical characteristics and comorbidities . The underprescription of these agents in the clinical practice is an issue which needs further examination in the future.