Utilisation of oral anticoagulants in older people with atrial fibrillation in UK general practice

Study identification

• EU PAS number:
  EUPAS29923
• Study ID:
  39711
• Official title and acronym:
  Utilisation of oral anticoagulants in older people with atrial fibrillation in UK general practice
• DARWIN EU® study:
  No
• Study countries:
  United Kingdom
• Study description:
  Atrial fibrillation (AF) is a heart condition that increases the risk of stroke. Blood thinning tablets known as oral anticoagulants (OACs) help to reduce the risk of stroke and guidelines recommend that OACs are prescribed to people with AF who also have other risk factors for stroke such as heart failure, high blood pressure or diabetes. Vitamin K antagonists (VKAs), such as warfarin, were the only OACs available. VKAs are difficult to manage as they require frequent blood tests and regular dose changes, they also interact with lots of other medicines and food. Historically, VKAs have been under-used in older people due to concerns about patients managing the complex dosing schedule if they have cognitive impairment, and also the risk of brain bleeds if they fall. Direct oral anticoagulants (DOACs) were introduced as an alternative to VKAs in 2008 but were not licensed for stroke prevention in AF until 2011. It is not known whether the introduction of DOACs has changed the rates of OAC prescribing for older people (aged 75 years and over) or how patient demographics, other medical conditions and concomitant prescribing affect the choice of OAC prescribed in UK general practice. The objectives of the study are: 1. To describe changes in the point prevalence and incidence of OAC prescribing by year prior to the introduction of DOACs (2003-2007), between the introduction of DOACs and the time they were recommended as an option by the National Institute for Health and Clinical Care Excellence (NICE) for stroke prevention in AF (2008-2012), and following publication of NICE technology appraisals recommending DOACs (2013-2017). 2. To describe switching between OACs during the study period. 3. To compare the characteristics of patients with AF who were newly started on OACs during each period described in objective 1, to those not prescribed an OAC in the same period. 4. To describe persistence with DOACs compared with warfarin.
• Study status:
  Ongoing

Research institutions and networks

Institutions

University of Bath

Study timelines

Date when funding contract was signed

Actual: 18/09/2018

Study start date

Actual: 01/05/2019

Data analysis start date

Planned: 30/07/2019

Actual: 31/07/2019

Date of final study report

Planned: 31/03/2021

Sources of funding

Non-for-profit organisation (e.g. charity)

More details on funding

The Dunhill Medical Trust

Regulatory

• Was the study required by a regulatory body?:
  No
• Is the study required by a Risk Management Plan (RMP)?:
  Not applicable