Initiation of rivaroxaban in patients with nonvalvular atrial fibrillation at the primary care level: the Swiss Therapy in Atrial Fibrillation for the Regulation of Coagulation (STAR) Study.
BACKGROUND
Rivaroxaban has become an alternative to vitamin-K antagonists (VKA) for stroke prevention in non-valvular atrial fibrillation (AF) patients due to its favourable risk-benefit profile in the restrictive setting of a large randomized trial. However in the primary care setting, physician's motivation to begin with rivaroxaban, treatment satisfaction and the clinical event rate after the initiation of rivaroxaban are not known.


METHODS
Prospective data collection by 115 primary care physicians in Switzerland on consecutive nonvalvular AF patients with newly established rivaroxaban anticoagulation with 3-month follow-up.


RESULTS
We enrolled 537 patients (73±11years, 57% men) with mean CHADS2 and HAS-BLED-scores of 2.2±1.3 and 2.4±1.1, respectively: 301(56%) were switched from VKA to rivaroxaban (STR-group) and 236(44%) were VKA-naïve (VN-group). Absence of routine coagulation monitoring (68%) and fixed-dose once-daily treatment (58%) were the most frequent criteria for physicians to initiate rivaroxaban. In the STR-group, patient's satisfaction increased from 3.6±1.4 under VKA to 5.5±0.8 points (P<0.001), and overall physician satisfaction from 3.9±1.3 to 5.4±0.9 points (P<0.001) at 3months of rivaroxaban therapy (score from 1 to 6 with higher scores indicating greater satisfaction). In the VN-group, both patient's (5.4±0.9) and physician's satisfaction (5.5±0.7) at follow-up were comparable to the STR-group. During follow-up, 1(0.19%; 95%CI, 0.01-1.03%) ischemic stroke, 2(0.37%; 95%CI, 0.05-1.34%) major non-fatal bleeding and 11(2.05%; 95%CI, 1.03-3.64%) minor bleeding complications occurred. Rivaroxaban was stopped in 30(5.6%) patients, with side effects being the most frequent reason.


CONCLUSIONS
Initiation of rivaroxaban for patients with nonvalvular AF by primary care physicians was associated with a low clinical event rate and with high overall patient's and physician's satisfaction.
Division of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital and University of Bern, Switzerland. Electronic address: rolf.engelberger@chuv.ch.
Rolf P
RP
Engelberger
HerzKlinik, Klinik Hirslanden, Zürich, Switzerland.
Georg
G
Noll
Private practice, Basel, Switzerland.
Dominique
D
Schmidt
Division of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Adriano
A
Alatri
Private practice, Oberriet SG, Switzerland.
Benedikt
B
Frei
DocWorld AG, Menzingen, Switzerland.
Walter E
WE
Kaiser
Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital and University of Bern, Switzerland; Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital, University Hospital and University of Bern, Switzerland.
Nils
N
Kucher
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control*; D013557:Switzerland; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use*
D065427:Factor Xa Inhibitors; D014812:Vitamin K; D000069552:Rivaroxaban
Atrial fibrillation; Primary care; Rivaroxaban; Stroke prevention; Treatment satisfaction