Adequacy of Oral Anticoagulants Treatment in Patients with Non-Valvular Atrial Fibrillation in Primary Health Care of Catalonia, Spain

Maria Rosa Dalmau Llorca ^1,2 José Fernández-Sáez ² Alessandra Queiroga Gonçalves ^2,3 Emma Forcadell Drago ^2,4 Dolors Rodríguez Cumplido ⁵ Carina Aguilar Martín ^2,6

¹Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut
²Unitat de Suport a la Recerca Terres de l’Ebre, IDIAP Jordi Gol
³Unitat Docent de Medicina de Família i Comunitària Terres de L`Ebre, Institut Català de la Salut
⁴Equip d’Atenció Primària Ulldecona-La Sénia, Institut Català de la Salut
⁵Servei de Farmacologia Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
⁶Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut

Background: The anticoagulant therapy (AT) is indicated to prevent stroke in patients with atrial fibrillation (AF) and embolic risk. There are currently two types of treatments: vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (DOACs). In our field, the indication of which treatment to be used is determined by the criteria of the Catalan Health Institute (ICS) or the Ministry of Health, Social Services and Equality (MH).
Objective: To assess the adequacy of AT in AF patients treated in the primary health care of ICS, Catalonia, Spain.
Methodology: Cross-sectional study with non-valvular AF patients in treatment with AT, using a Catalan population database (SIDIAP) for the extraction of the data. Adequacy criteria considered: 1. ICS criterion: first choice VKA; DOAC if poor control of the International Normalized Ratio or contraindication of VKA; 2. MH criterion: all the previously mentioned ICS criteria and history of intracranial hemorrhage, ischemic stroke with HAS-BLED≥3 and severe arterial thromboembolic events.
Results: 82.9% of the 52,217 patients took VKA and 17.1% DOAC. The prevalence of VKA adequacy according to ICS criterion was 51.2% (IC95% 50,7%-51,7%) and according to MS criterion, 58.5% (IC95% 58,1%-59,0%) (p<0,001). The prevalence of DOAC adequacy according to ICS criterion was 16,7% (IC95% 15,9%-17,5%) and according to MS criterion, 78,6% (IC95% 77,7%-79,4%) (p<0,001).
Conclusions: The adequacy is low, especially according to the ICS criterion. A tool that reports real-time control of VKA anticoagulation (Rosendaal formula) could help professionals and could improve the adequacy of AT.