Patient and physician characteristics associated with therapy initiation and switch to Non-vitamin K oral anticoagulants

Aims: To explore the usage of Non-vitamin k oral anticoagulants (NOAC) and vitamin K antagonists (VKA) in contemporary clinical practice, as well as the patient and physician characteristics associated with NOAC prescription.

Methods: The Maccabi Health Services database, a 2.3-million-member healthcare provider in Israel, was searched to identify patients with non-valvular atrial fibrillation (NVAF) for whom either a VKA or NOAC was prescribed between 2012 and 2015. Patients were grouped as either previously diagnosed with NVAF and treated with OAC (prevalent cases) or newly diagnosed patients with NVAF (incident cases). Frequencies and multivariate analyses were performed to demonstrate patients’ and physicians’ indices associated with NOAC prescription.

Results: The study consisted of 4,120 incident cases and 4,969 prevalent cases. The proportion of NOAC prescription among the incident cases increased from 32% to 68.4%. During follow-up, 51.2% of the prevalent patients were switched to NOAC from VKA. High CHA₂DS₂-VASc score was significantly associated with NOAC prescription among the incident and prevalent cases. Compared with general practitioners, cardiologists were 8 times more likely to prescribe NOAC (OR 8.4 [95% CI; 2.7-23.1]). Compared with younger physicians, senior physicians (born before 1950) were less likely to prescribe NOAC (OR 0.47 [95% CI; 0.24-0.96])

Conclusions: Although NOAC acceptance is increasing, discrepancies in prescription exist both due to patients’ and physicians’ characteristics. An effort to improve this observation should focus on newly diagnosed eligible patients with low CHA₂DS₂-VASc score and senior primary care physicians.