Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians

Christopher X. Wong, Sarah W. Lee, Siang Wei Gan, Rajiv Mahajan, Geetanjali Rangnekar, Rajeev K. Pathak, Darragh Twomey, Carlee Schultz, Anand N. Ganesan, Anthony G. Brooks, Kurt C. Roberts-Thomson, Alex Brown, Dennis H. Lau, Prashanthan Sanders

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. Methods Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. Results 19,613 individuals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p < 0.001) and thus had lower CHADS2- (1.19 ± 0.32 vs 1.99 ± 0.47, p < 0.001) and CHA2DS2VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p < 0.001). Correspondingly, the percentage of Indigenous Australians with CHADS2 ≥ 2 (39.6% vs 44.1%, p < 0.001) and CHA2DS2VASc-scores ≥ 2 (62.9% vs 78.8%, p < 0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1% and 68.9% of Indigenous and non-Indigenous Australians with CHADS2 scores ≥ 2, and 76.3% and 71.3% with CHA2DS2VASc scores ≥ 2, were under-anticoagulated. Similarly, 27.4% and 24.1% of Indigenous and non-Indigenous Australians with CHADS2 scores = 0, and 24.0% and 16.7% with CHA2DS2VASc-scores = 0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS2- or CHA2DS2VASc-score (p = 0.045 and p < 0.001 respectively). Conclusion Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.

LanguageEnglish
Pages20-24
Number of pages5
JournalInternational Journal of Cardiology
Volume191
DOIs
Publication statusPublished - 15 Jul 2015

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Ethnicity
  • Indigenous
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Wong, Christopher X. ; Lee, Sarah W. ; Gan, Siang Wei ; Mahajan, Rajiv ; Rangnekar, Geetanjali ; Pathak, Rajeev K. ; Twomey, Darragh ; Schultz, Carlee ; Ganesan, Anand N. ; Brooks, Anthony G. ; Roberts-Thomson, Kurt C. ; Brown, Alex ; Lau, Dennis H. ; Sanders, Prashanthan. / Underuse and overuse of anticoagulation for atrial fibrillation : A study in Indigenous and non-Indigenous Australians. In: International Journal of Cardiology. 2015 ; Vol. 191. pp. 20-24.
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abstract = "Background Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. Methods Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. Results 19,613 individuals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p < 0.001) and thus had lower CHADS2- (1.19 ± 0.32 vs 1.99 ± 0.47, p < 0.001) and CHA2DS2VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p < 0.001). Correspondingly, the percentage of Indigenous Australians with CHADS2 ≥ 2 (39.6{\%} vs 44.1{\%}, p < 0.001) and CHA2DS2VASc-scores ≥ 2 (62.9{\%} vs 78.8{\%}, p < 0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1{\%} and 68.9{\%} of Indigenous and non-Indigenous Australians with CHADS2 scores ≥ 2, and 76.3{\%} and 71.3{\%} with CHA2DS2VASc scores ≥ 2, were under-anticoagulated. Similarly, 27.4{\%} and 24.1{\%} of Indigenous and non-Indigenous Australians with CHADS2 scores = 0, and 24.0{\%} and 16.7{\%} with CHA2DS2VASc-scores = 0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS2- or CHA2DS2VASc-score (p = 0.045 and p < 0.001 respectively). Conclusion Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.",
keywords = "Anticoagulation, Atrial fibrillation, Ethnicity, Indigenous, Stroke",
author = "Wong, {Christopher X.} and Lee, {Sarah W.} and Gan, {Siang Wei} and Rajiv Mahajan and Geetanjali Rangnekar and Pathak, {Rajeev K.} and Darragh Twomey and Carlee Schultz and Ganesan, {Anand N.} and Brooks, {Anthony G.} and Roberts-Thomson, {Kurt C.} and Alex Brown and Lau, {Dennis H.} and Prashanthan Sanders",
year = "2015",
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doi = "10.1016/j.ijcard.2015.03.064",
language = "English",
volume = "191",
pages = "20--24",
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publisher = "Elsevier Ireland Ltd",

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Wong, CX, Lee, SW, Gan, SW, Mahajan, R, Rangnekar, G, Pathak, RK, Twomey, D, Schultz, C, Ganesan, AN, Brooks, AG, Roberts-Thomson, KC, Brown, A, Lau, DH & Sanders, P 2015, 'Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians', International Journal of Cardiology, vol. 191, pp. 20-24. https://doi.org/10.1016/j.ijcard.2015.03.064

Underuse and overuse of anticoagulation for atrial fibrillation : A study in Indigenous and non-Indigenous Australians. / Wong, Christopher X.; Lee, Sarah W.; Gan, Siang Wei; Mahajan, Rajiv; Rangnekar, Geetanjali; Pathak, Rajeev K.; Twomey, Darragh; Schultz, Carlee; Ganesan, Anand N.; Brooks, Anthony G.; Roberts-Thomson, Kurt C.; Brown, Alex; Lau, Dennis H.; Sanders, Prashanthan.

In: International Journal of Cardiology, Vol. 191, 15.07.2015, p. 20-24.

Research output: Contribution to journalArticle

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T1 - Underuse and overuse of anticoagulation for atrial fibrillation

T2 - International Journal of Cardiology

AU - Wong, Christopher X.

AU - Lee, Sarah W.

AU - Gan, Siang Wei

AU - Mahajan, Rajiv

AU - Rangnekar, Geetanjali

AU - Pathak, Rajeev K.

AU - Twomey, Darragh

AU - Schultz, Carlee

AU - Ganesan, Anand N.

AU - Brooks, Anthony G.

AU - Roberts-Thomson, Kurt C.

AU - Brown, Alex

AU - Lau, Dennis H.

AU - Sanders, Prashanthan

PY - 2015/7/15

Y1 - 2015/7/15

N2 - Background Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. Methods Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. Results 19,613 individuals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p < 0.001) and thus had lower CHADS2- (1.19 ± 0.32 vs 1.99 ± 0.47, p < 0.001) and CHA2DS2VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p < 0.001). Correspondingly, the percentage of Indigenous Australians with CHADS2 ≥ 2 (39.6% vs 44.1%, p < 0.001) and CHA2DS2VASc-scores ≥ 2 (62.9% vs 78.8%, p < 0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1% and 68.9% of Indigenous and non-Indigenous Australians with CHADS2 scores ≥ 2, and 76.3% and 71.3% with CHA2DS2VASc scores ≥ 2, were under-anticoagulated. Similarly, 27.4% and 24.1% of Indigenous and non-Indigenous Australians with CHADS2 scores = 0, and 24.0% and 16.7% with CHA2DS2VASc-scores = 0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS2- or CHA2DS2VASc-score (p = 0.045 and p < 0.001 respectively). Conclusion Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.

AB - Background Atrial fibrillation (AF) is a leading cause of preventable stroke in Australia. Given that anticoagulation therapy can significantly reduce this stroke risk, we sought to characterise anticoagulation use in Indigenous and non-Indigenous Australians with AF. Methods Administrative, clinical and prescription data from patients with AF were linked. Anticoagulation use was characterised according to guideline-recommended risk scores and Indigenous status. Results 19,613 individuals with AF were studied. Despite a greater prevalence of other risk factors, Indigenous Australians were significantly younger than their non-Indigenous counterparts (p < 0.001) and thus had lower CHADS2- (1.19 ± 0.32 vs 1.99 ± 0.47, p < 0.001) and CHA2DS2VASc-scores (1.47 ± 0.03 vs 2.82 ± 0.08, p < 0.001). Correspondingly, the percentage of Indigenous Australians with CHADS2 ≥ 2 (39.6% vs 44.1%, p < 0.001) and CHA2DS2VASc-scores ≥ 2 (62.9% vs 78.8%, p < 0.001) was also lower. Indigenous Australians, however, had greater rates of under- and over-anticoagulation. Overall, 72.1% and 68.9% of Indigenous and non-Indigenous Australians with CHADS2 scores ≥ 2, and 76.3% and 71.3% with CHA2DS2VASc scores ≥ 2, were under-anticoagulated. Similarly, 27.4% and 24.1% of Indigenous and non-Indigenous Australians with CHADS2 scores = 0, and 24.0% and 16.7% with CHA2DS2VASc-scores = 0, were over-anticoagulated. In multivariate analyses, Indigenous Australians were more likely to receive under- or over-anticoagulation according to CHADS2- or CHA2DS2VASc-score (p = 0.045 and p < 0.001 respectively). Conclusion Anticoagulation for AF is frequently not prescribed in accordance with guideline recommendations. Under-anticoagulation in those at high stroke risk, and over-anticoagulation in those at low risk, is common and more likely in Indigenous patients with AF. Improving adherence to guideline recommendations for anticoagulation in AF may reduce both ischaemic and haemorrhagic strokes in Indigenous and non-Indigenous Australians.

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KW - Atrial fibrillation

KW - Ethnicity

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KW - Stroke

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