Uptake of non-vitamin K antagonist oral anti coagulants in patients with atrial fibrillation - a prospective cohort study.
We aimed to assess the uptake of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation between 2010 and 2015 in Switzerland.



We performed a prospective observational cohort study. At the baseline examination and during yearly follow-ups, we used questionnaires to obtain information about clinical characteristics and antithrombotic treatment. Stroke risk was assessed using the CHA2DS2-VASc score.



1545 patients were enrolled across seven centres in Switzerland. Mean age was 68 ± 12 years and 29.5% were female. The percentage of anticoagulated patients with an indication for oral anticoagulation (CHA2DS2-VASc score ≥2 in women and ≥1 in men) was 75% in 2010 and 80% in 2015 (p = 0.2). There was a gradual increase in the use of NOACs from 0% in 2010 to 29.8% in 2015 (p <0.0001). Out of 888 patients, who initially received a vitamin K antagonist (VKA), 86 (9.7%) were switched to an NOAC during follow-up. Use of aspirin as a monotherapy decreased from 23% in 2010 to 11% in 2015 (p <0.0001).



After regulatory approval, the use of NOACs in Switzerland steadily increased to about 30% in 2015, whereas switches from VKAs to NOACs were infrequent. In parallel, the prescription of aspirin as monotherapy was more than halved, suggesting significant guideline-concordant improvements in oral anticoagulation use among patients with atrial fibrillation.
Department of Medicine, University Hospital Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
Matylda
M
Zimny
Department of Medicine, University Hospital Basel, Switzerland; b Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland.
Steffen
S
Blum
Division of Cardiology, Kantonsspital St. Gallen, Switzerland.
Peter
P
Ammann
Lab Signal Transduction, Department of Biomedicine, University of Basel, Switzerland.
Paul
P
Erne
Division of Cardiology, Ospedale Regionale di Lugano, Ticino, Switzerland.
Giorgio
G
Moschovitis
Division of Cardiology, Ospedale San Giovanni di Bellinzona, Ticino, Switzerland.
Marcello
M
Di Valentino
Division of Cardiology, University Hospital Geneva, Switzerland.
Dipen
D
Shah
Jürg
J
Schläpfer
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
Cyrill
C
Vogt
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Medicine, Regionalspital Surselva, Graubünden, Switzerland.
Alexandra
A
Tabord
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; c Division of Cardiology, University Hospital Basel, Switzerland.
Michael
M
Kühne
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland.
Christian
C
Sticherling
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland.
Stefan
S
Osswald
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Canada.
David
D
Conen
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control; D013557:Switzerland
D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D000069604:Dabigatran