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Thromb Haemost 2010; 103(05): 968-975
DOI: 10.1160/TH09-08-0525
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

A national survey of the management of atrial fibrillation with antithrombotic drugs in Italian primary care

Giampiero Mazzaglia
1   Health Search, Italian College of General Practitioners, Florence, Italy
,
Alessandro Filippi
2   Italian College of General Practitioners, Florence, Italy
,
Marianna Alacqua
3   IRCCS Centro Neurolesi ‘Bonino-Pulejo’, Messina, Italy
,
Warren Cowell
4   Bayer HealthCare, Uxbridge, UK
,
Annabelle Shakespeare
4   Bayer HealthCare, Uxbridge, UK
,
Lorenzo G. Mantovani
5   CIRFF – Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
,
Cosetta Bianchi
6   Bayer HealthCare, Milan, Italy
,
Claudio Cricelli
2   Italian College of General Practitioners, Florence, Italy
› Author Affiliations
Further Information

Publication History

Received: 03 August 2009

Accepted after major revision: 05 January 2010

Publication Date:
22 November 2017 (online)

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Summary

The aims of this study were to investigate trends in the incidence of diagnosed atrial fibrillation (AF), and to identify factors associated with the prescription of antithrombotics (ATs) and to identify the persistence of patients with oral anticoagulant (OAC) treatment in primary care. Data were obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database from 2001 to 2004. The age-standardised incidence of AF was: 3.9–3.0 cases, and 3.6–3.0 cases per 1,000 person-years in males and females, respectively. During the study period, 2,016 (37.2%) patients had no prescription, 1,663 (30.7%) were prescribed an antiplatelet (AP) agent, 1,440 (26.6%) were prescribed an OAC and 301 (5.5%) had both prescriptions. The date of diagnosis (p = 0.0001) affected the likelihood of receiving an OAC. AP, but not OAC, use significantly increased with a worsening stroke risk profile using the CHADS2 risk score. Older age increased the probability (p < 0.0001) of receiving an AP, but not an OAC. Approximately 42% and 24% of patients persisted with OAC treatment at one and two years, respectively, the remainder interrupted or discontinued their treatment. Underuse and discontinuation of OAC treatment is common in incident AF patients. Risk stratification only partially influences AT management.

Keywords

Antithrombotics - atrial fibrillation - incidence - oral anticoagulant - risk stratification - therapeutic persistence - treatment
 

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