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Thromb Haemost 2012; 107(06): 1053-1065
DOI: 10.1160/TH11-11-0768
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Oral anticoagulation use by patients with atrial fibrillation in Germany

Adherence to guidelines, causes of anticoagulation under-use and its clinical outcomes, based on claims-data of 183,448 patients
Thomas Wilke
1   Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany
,
Antje Groth
1   Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany
,
Sabrina Mueller
1   Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany
,
Matthias Pfannkuche
2   Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany
,
Frank Verheyen
3   Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG), Techniker Krankenkasse, Hamburg, Germany
,
Roland Linder
3   Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG), Techniker Krankenkasse, Hamburg, Germany
,
Ulf Maywald
4   AOK Plus, Dresden, Germany
,
Thomas Kohlmann
5   Institut für Community Medicine, Abteilung Methoden, Universität Greifswald, Germany
,
You-Shan Feng
5   Institut für Community Medicine, Abteilung Methoden, Universität Greifswald, Germany
,
Günter Breithardt
6   Department of Cardiology and Angiology, Universität Münster, Germany
,
Rupert Bauersachs
7   Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
› Institutsangaben Financial support: The study was funded by Boehringer Ingelheim Pharma GmbH, Germany. The study design, the collection/analysis of data and the writing of the manuscript were done independently of the funding source.
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Publikationsverlauf

Received: 06. November 2011

Accepted after major revision: 06. Februar 2012

Publikationsdatum:
29. November 2017 (online)

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Summary

Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder. Oral anticoagulation (OAC) is recommended by guidelines in the presence of a moderate to high risk of stroke. Based on an analysis of claims-based data, the aim of this contribution is to quantify the stroke-risk dependent OAC utilisation profile of German AF patients as well as the possible causes and the associated clinical outcomes of OAC under-use. Our data set was derived from two large mandatory German medical insurance funds. Risk stratification of patients was based on the CHADS2-score and the CHA2DS2-VASc-score. Two different scenarios were constructed to deal with factors potentially disfavouring OAC use. Causes of OAC under-use and its clinical consequences were analysed using multivariate analysis. Observation year was 2008. A total of 183,448 AF patients met the inclusion criteria. This represents an AF prevalence of 2.21%. The average CHADS2-score was 2.8 (CHA2DS2-VASc-score: 4.3). On between 40.5 and 48.7% of the observed patient-days, there was no antithrombotic protection by OAC, other anticoagulants or aspirin. Older female patients with a high number of comorbidities had a higher risk of OAC under-use. Patients who had already experienced a thromboembolic event had a lower risk of OAC under-use. In the observation year, 3,367 patients experienced a stroke (incidence rate 1.8%). In our multi-level Poisson random effects estimate, OAC use decreases the stroke rate by almost 80% (IRR 0.236). In conclusion, OAC under-use is widespread in the German market. It is associated with severe clinical consequences.

Keywords

Vitamin K-dependent factors - antiplatelet agents - management of disease
 

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