title: Changes in Oral Anticoagulant Treatment Rates in Atrial Fibrillation before and after the Introduction of Direct Oral Anticoagulants.
abstract: Direct oral anticoagulants (DOACs) have the potential to improve stroke prevention among atrial fibrillation (AF) patients. We sought to determine if oral anticoagulation (OAC) treatment rates have increased since the approval of DOACs.
  
  
  
  We identified 6,688 patients with AF at an academic medical center from January 2008 to June 2015. We examined OAC prescription rates over time and according to CHA2DS2VASc score using multivariable Poisson regression models, with an interaction term between risk score and year of AF diagnosis.
  
  
  
  Among 6,688 AF patients, 78% had CHA2DS2VASc scores ≥2, 51.6% of whom received an OAC prescription within 90 days of diagnosis. The OAC prescription rate was 47.8% in the pre-DOAC era and peaked at 56.4% in 2014. Relative to the pre-DOAC era, prescription rates increased in 2012 and leveled off thereafter. The prescription rate for the highest risk group was 58.5%, compared with 45.0% in patients with a CHA2DS2VASc score of 2 (p < 0.01). In the adjusted analysis, prescription rates were higher for the higher risk group (adjusted relative risk 1.24 for CHA2DS2VASc score 7-9 vs. 2, 95% CI 1.09-1.40).
  
  
  
  OAC treatment rates have increased since DOAC introduction, but substantial treatment gaps remain, specifically among the higher risk patients.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Rashmee U
authors.initials: RU
authors.lastname: Shah
authors.forename: Austin B
authors.initials: AB
authors.lastname: Rupp
authors.forename: Danielle
authors.initials: D
authors.lastname: Mowery
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Zhang
authors.forename: Greg
authors.initials: G
authors.lastname: Stoddard
authors.forename: Vikrant
authors.initials: V
authors.lastname: Deshmukh
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Bray
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rondina
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants