| アブストラクト | RATIONALE, AIMS, AND OBJECTIVES: Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. METHOD: Data were extracted from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics secondary care and Office for National Statistics mortality data. RESULTS: Of 42 966 patients with a first AF record between 2011 and 2016, 9143 patients (21.3%) remained without AF (antiplatelets/antithrombotics) treatment post-index diagnosis. The proportion of patients receiving aspirin for >/=3 months post-index declined during the study (50.6%-5.5%), irrespective of CHA2 DS2 -VASc score, while the proportion prescribed NOACs increased (2.0%-70.1%). Rates of ischaemic stroke per 1000 patient-years (95% CI) were 9.4 (3.8-15.0) with NOACs, 10.4 (8.0-12.9) with warfarin, 20.1 (16.4-23.8) with aspirin, 21.3 (5.3-37.2) with other antiplatelets and 43.6 (39.3-47.8) in patients without AF prescription. Major bleeding occurred at a similar rate with different treatments. All-cause mortality rates were 42.8 (31.4-54.3) with NOACs, 46.3 (41.1-51.5) with warfarin, 56.5 (50.5-62.4) with aspirin, 102.2 (76.2-128.3) with other antiplatelets and 412.8 (399.6-426.0) with no AF prescription. Mean annual National Health Service healthcare costs up to 1 year post-index were lowest in patients receiving aspirin plus other antiplatelets without an event ( pound6152), and highest in patients with an event without AF prescriptions ( pound17 957). By extrapolation, national AF HRU in the United Kingdom in 2016 was estimated at pound8-16 billion annually. CONCLUSIONS: These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions. |
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| ジャーナル名 | Journal of evaluation in clinical practice |
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| 投稿日 | 2020/4/22 |
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| 投稿者 | Bakhai, Ameet; Petri, Hans; Vahidnia, Farnaz; Wolf, Cyrill; Ding, Yingjie; Foskett, Nadia; Sculpher, Mark |
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| 組織名 | Royal Free London NHS Foundation Trust, Barnet General Hospital, Cardiology;Department, Barnet, and Amore Health Ltd, London, UK.;Petri Consulting Ltd, St. Albans, UK.;Real-World Data Group, Diagnostics Information Solutions, Pleasanton, California,;USA.;Roche Diagnostics International Ltd, Rotkreuz, Switzerland.;Genesis Research Ltd, Hoboken, New Jersey, USA.;Roche Products Ltd, Welwyn Garden City, UK.;Centre for Health Economics, University of York, York, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32314853/ |
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