title: Antithrombotic therapy in patients with non-valvular atrial fibrillation in Southern Sweden: A population-based cohort study.
abstract: BACKGROUND
  Oral anticoagulants in patients with atrial fibrillation (AF) with moderate-to-high stroke risk are strongly recommended by the current guidelines.
  
  
  METHODS
  Population-based register study of all 13,837 patients with incident non-valvular AF diagnosed during 2011-2014 in primary and secondary care (including all in- and outpatient visits) in Skåne County, Sweden. The outcome was the prescription of direct-acting oral anticoagulants (DOAC), warfarin or acetylsalicylic acid (ASA).
  
  
  CONCLUSIONS
  Guideline adherence increased from 47.6% in 2011 to 66.1% in 2014, mostly due to decrease in undertreatment. In patients with CHA2DS2-VASc score ≥ 2, ASA uptake decreased from 29.9% to 14.7% and DOAC uptake increased from 2.1% to 25.1%. The use of ASA was more common among elderly and with increasing stroke- and bleeding risk. Overall, 47.4% of patients with CHA2DS2-VASc score ≥ 2 did not receive oral anticoagulants. Undertreatment was particularly common in women < 65 years (55.8%) and in patients > 84 years (65.3% in women and 62% in men). Overtreatment of patients at low stroke risk was 35.9% in men and 36.4% in women. Provider speciality affected the choice of treatment only to a minor degree. Despite increasing guideline adherence, there is a suboptimal use of antithrombotic therapy in a large proportion of AF patients diagnosed in different clinical settings. Efforts to further improve guideline adherence should particularly be targeted on women < 65 years, elderly > 84 years and patients at low stroke risk.
authors.affiliation: Department of Cardiology, Skåne University Hospital, Malmö S-20502, Sweden.
authors.forename: Natalia
authors.initials: N
authors.lastname: Mochalina
authors.affiliation: Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, S-22185 Lund, Sweden; Epidemiology and Register Centre South, S-22381 Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Jöud
authors.affiliation: Department of Medicines Management and Informatics, Region Skåne, S-21120 Malmö, Sweden.
authors.forename: Maj
authors.initials: M
authors.lastname: Carlsson
authors.affiliation: Epidemiology and Register Centre South, S-22381 Lund, Sweden; Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
authors.forename: Maria E C
authors.initials: MEC
authors.lastname: Sandberg
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Själander
authors.affiliation: Department of Cardiology, Skåne University Hospital Malmö, S-20502 Malmö, Sweden.
authors.forename: Tord
authors.initials: T
authors.lastname: Juhlin
authors.affiliation: Department of Coagulation Disorders, Skåne University Hospital Malmö, S-20502 Malmö, Sweden.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Svensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology; D013548:Sweden; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
keywords: Anticoagulants; Atrial fibrillation; Guideline adherence; Hemorrhage; Stroke