Gender differences in the management of antithrombotic prescriptions among patients with atrial fibrillation by general practitioners in France

Abstract

Purpose: Around 800,000 patients are diagnosed for atrial fibrillation (AF) in France with an increased risk of stroke. CHA2DS2-VASc score is a refinement of the CHADS2 score to aid the decision of using anticoagulation adding female sex as a specific risk. This study was to describe AF patients' management by general practitioners (GPs) and to assess factors associated with VKA prescription. Methods: This is a cross-sectional database study of a representative sample of 1,200 French GPs (07/2010 to 06/2011). Patients with a diagnosis of AF >18 y.o. were extracted. Factors associated with the choice of treatment were identified using a multivariate multinomial model. Results: A total of 15,623 AF patients were analyzed. Mean age was 74.6 (+/-11.1) years old, mean CHA2DS2-VASc was 2.9 (+/-1.5) and 40.5% of patients were women. In total, 25.1% had no treatment, 50.7%, 19.9% and 4.3% were treated with VKA, aspirin and clopidogrel (+/-aspirin), respectively. Univariate analyses showed that women were significantly less treated than men, 28.6% vs 22.8% (OR: 0.74; 0.69-0.79). An age-stratified (<75 & >75 years) multivariate analysis showed three criteria significantly associated with the VKA prescription: CHADS2-VASC score (Table 1), athero-thrombotic disease (OR 1.25; 0.98-1.59; p=0.074), concomitant treatments of anti-arrhythmic (AA) (OR: 4.4; 3.82-5.17; p< 0.0001) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR:0.47; 0.36-0.61; p<0.0001). In opposite, two criteria were significantly associated with the absence of VKA prescription: being a woman and chronic NSAIDs prescription. (Table presented) Conclusions: In this large French AF patient database in primary care, women are under-treated compared with men whatever the level risk of stroke and co-morbidities. Further improvement of adherence to guidelines by physicians is needed, especially for women, to optimize the management of AF.