Oral anticoagulation use increases for AF, stroke admissions decrease in Italy
PARIS — The use of oral anticoagulation increased as the prescriptions of antiplatelet agents decreased in patients with atrial fibrillation from 2012 to 2015 in Italy, according to data presented at the European Society of Cardiology Congress.
During this time, there was a decrease in admission rates for ischemic stroke, whereas admission rates for major bleeds or intracerebral hemorrhages did not substantially change, according to the presentation. There were also decreases in the total cost per patient with AF in 2015.
Aldo P. Maggioni, MD, director of the ANMCO Research Center in Florence, Italy, and colleagues analyzed data from 194,030 patients from the Ricerca e Salute database who were discharged with a primary or secondary diagnosis of AF between 2012 and 2015.
Patients were followed for 1 year after discharge for further hospitalizations and medications. Italian National Health Service costs were assessed during 1-year follow-up and were based on outpatient specialist services, drug prescriptions and hospitalizations.
The rate of AF admissions was relatively the same during this period, with 3.98% per 1,000 patients in 2012 and 4.35% per 1,000 patients in 2015.
The mean age of patients in 2012 and 2013 was 77 years, and 78 years in 2014 and 2015. There were at least 50% women in the study during this period. There were slight increases in the number of patients with HF, diabetes, hypertension or chronic obstructive pulmonary disease at baseline.
The rate of prescription for vitamin K antagonists decreased from 55.9% in 2012 to 36.7% in 2015. A decrease was also seen in the prescription of antiplatelet from 2012 to 2015 (42.6% to 28.1%). In contrast, there was an increase in the prescription rate of dual oral anticoagulants from 2012 to 2015 (0.8% to 27.7%).
There were no major differences in the prescriptions of diuretics, beta-blockers and lipid-lowering agents. There were some decreases during this period in the prescription of ACE inhibitors (62% to 56.6%), antiarrhythmics (28.2% to 24.8%), digitalis (30.1% to 20.8%) and calcium channel blockers (19% to 15.3%).
“It was interesting to see that the class of drug more prescribed in patients with atrial fibrillation was proton pump inhibitors without clear evidence of a beneficial effect,” Maggioni said during the presentation.
During this time, there were reductions in ischemic stroke (21.3% to 14.7%) and hemorrhagic stroke (6.5% to 4.1%) as the major causes for readmissions at 1 year. There was also an increase in major bleeds as the main case for readmission (1.5% to 2.3%).
The integrated yearly costs per patient did not significantly change from 2012 to 2015 (5,927 euros to 5,239 euros), but the greatest decline was seen from 2014 to 2015 (6,461 euros to 5,239 euros).
“The reduction of the cost was mainly due to some reduction in the cost for hospitalization and the reduction of the cost for any kind of drugs,” Maggioni said during the presentation. “This was mainly due to the fact that several drugs became generics.” – by Darlene Dobkowski
Maggioni AP. Late-Breaking Science in Atrial Fibrillation 1. Presented at: European Society of Cardiology Congress; Aug. 31-Sept. 4, 2019; Paris.
Disclosure: Analysis of the Ricerca e Salute database was partially supported by Bayer Italy. Maggioni reports he received fees for participation in study committees sponsored by Bayer, Fresenius and Novartis.