Z.LIM1, K.J.LEW2, E.S.LEE2
National Healthcare Group Polyclinics1, NHGP HQ2
Anticoagulation is the cornerstone of stroke prevention for at-risk patients with atrial fibrillation. The aim of this study is to analyze the use of anticoagulants and anti-platelets in patients with atrial fibrillation, over the course of 5 years, in five polyclinics.
A serial cross-sectional analysis was carried out retrospectively for patients with atrial fibrillation who regularly visit five NHGP polyclinics from Jan 2015 to Dec 2019. Patient characteristics, medication use and investigations were gathered. Time-in-therapeutic-range (TTR) was calculated for patients taking warfarin based on the Rosendaal method.
A total of 986 patients with a mean age of 71.1years were recruited. 88.2% of patients have a CHA2DS2VASc score of ≥ 2. Among at-risk patients, 61.6%, 24.8%, and 6.1% were taking warfarin, anti-platelets, and combination therapy (warfarin and anti-platelets) respectively in the first year. 7.5% of the patients were not taking anticoagulant or anti-platelet agent. The percentage of patients on warfarin remained stable, while there is an increasing proportion of patients given a non-vitamin K antagonist oral anticoagulant (NOAC), amounting to 11.0% of the cohort by 2019. Patients not on therapy, taking anti-platelets, or on combination therapy have decreased over the years. For patients on warfarin, the mean TTR was 75.3±25.3%. Proportion of patients with TTR ≥65% increased steadily from 70.5% to 74.3% by 2019.
The anticoagulation management of at-risk patients with atrial fibrillation improved over the 5-year period, evident by increasing proportion of patients who receive anticoagulants, attained better TTR, and decreasing proportions of patients not on therapy or taking anti-platelets.