Trends in Oral Anticoagulant Therapy In Patients with None-Valvular Atrial Fibrillation in the Clalit Health Services HMO in Israel: Focus on Noval Oral Anti-Coagulants adoption

The Noval Oral Anti-Coagulants – (NOAC) revolutionized anticoagulant therapy in atrial fibrillation.
Real-life data on NOAC utilization in Israel is still sparse.

Aim of the study: 1. To describe clinical, organizational and social predictors for utilization over time of NOAC and VKA, in a large public health organization setting. 2. Predictors for inadequate therapy with VKA and NOAC and clinical outcome.

Methods: From the North district Clalit health organization’s computerized data base, data were extracted on patients in whom diagnosis of None-Valvular Atrial Fibrillation (NVAF) was recorded between 1/1/2012-31/12/2015.

Results: In 2012 there were 6414 pts with diagnosis of NVAF and a CHADS score ≥1. 2702 pts (42.1%) were treated with VKA. Of these, 793 pts (29.4%) with TTR≥70%. In 2013 NOAC therapy was initiated in 384 pts (6%). By the end of 2015, there were 6956 NVAF pts, 2032 (29.2%) were treated by VKA, 508 pts (25.0%) with TTR≥70%. 2008 pts (28.9%) were treated by NOAC. Only 1110 pts (55.3%) were treated by appropriate dose of NOAC (APPD-NOAC). Thus, only 1618 pts (40.0%) were treated appropriately by OAC. Most pts treated by NOAC (81.0%) were covered by the health basket.
In multivariate analysis, predictors for NOAC therapy were age, marital status, ethnic group, eligibility for NOAC in health basket, Mushlan insurance and CHADS score. Multivariate Predictors for adequate OAC therapy (TTR≥70 or APPD-NOAC), were age>75, married status, ethnic group, eligibility for NOAC in health basket but not CHADS score.
Multivariate Predictors for Survival were young age, married status, NOAC therapy, appropriate OAC therapy, and CHADS score but not ethnic group.

Conclusion: Most patients in our study were not treated adequately with OAC. Predictors for NOAC therapy and adequate OAC therapy are socioeconomical as well as clinical. Inadequate OAC therapy both by VKA and NOAC is associated with poor outcome.