Half of Australian high-risk atrial fibrillation patients aren’t prescribed anti-coagulants, but a free program has been launched to fix that.
Around half of high-risk atrial fibrillation patients are not prescribed anti-coagulants, and around half of the treatment group stop within 2.5 years, according to Australian data.
But a new initiative aimed at improving anticoagulant use, by the Quality Use of Medicines Alliance and funded by the Australian Government and led by Medcast, seeks to change that.
“Preventable strokes in patients with AF are occurring unnecessarily in Australia. There is an urgent need for health professionals to detect and manage AF and initiate anticoagulant therapy based on risk scores,” the authors of a new review article in the Australian Journal of General Practice wrote.
The article, published to coincide with the April launch of the free QHUB oral anticoagulants program, said that while prescription rates appeared to be increasing, knowledge gaps existed around the best way to treat people with these medications.
“The appropriate use of anticoagulants in non-valvular AF can reduce the risk of ischaemic stroke by 64% and the risk of death by 26%. Given the efficacy of anticoagulants, it is surprising and concerning that only about half of eligible patients are on anticoagulants,” the authors wrote.
This gap drove the development of a comprehensive national education program for doctors and patients. The website includes educational and peer group learning resources, interactive webinars, online clinical cases, practice audits and point-of-care tools.
“By providing targeted education, we aim to improve the rate of anticoagulant prescriptions when they are needed and to increase ongoing use by patients, ultimately saving lives and reducing the burden of stroke in our community,” Associate Professor Stephen Barnett, medical director at Medcast, said in a statement.
The RACGP, which is another of the eight groups comprising the Quality Use of Medicines Alliance, welcomed the resource.
“It is in the realm of GPs to identify and manage patients with atrial fibrillation which can be missed, particularly if it is intermittent or doesn’t cause symptoms. GPs should take any opportunity to screen for AF in at risk populations,” RACGP spokesperson Prof Nigel Stocks told media.
“Once diagnosed, patients may be reluctant to take anticoagulants, so it is important that they fully understand their individual stroke and bleeding risk so they can make informed decisions about future care.”
It is estimated that half a million Australians are affected by AF, and it contributes to almost one in 10 deaths. The problem will grow alongside our ageing and increasingly comorbid population.
But managing AF could be challenging and was hampered by the lack of defined screening program, the authors of the AGJP article said.
“So it remains the remit of the general practitioner (GP) and community health professionals to opportunistically find high-risk cases,” they wrote.
“We know that there is uncertainty about when, how and who to screen; when and how to initiate oral anticoagulants; which agents to choose; periprocedural management; and what information to provide to patients.”
It could also be a challenge to achieve ongoing compliance, they added.
“Health professionals tend to discount the stroke risk of AF that is intermittent or asymptomatic, further contributing to underuse of anticoagulants,” they wrote.
While clinicians could be hesitant to prescribe oral anticoagulants in older and frail patients, evidence suggested the risk of stroke rose more than the risk of bleeding as people aged, the authors said.
“Because DOACs require less monitoring than warfarin, there is a tendency towards a ‘set and forget’ approach. Prescribers tend to overlook the dynamic nature of stroke and bleeding risk assessment, which requires ongoing review and re-evaluation,” the authors wrote.
“The program supports both health professionals and adults with AF (and their carers) with resources that provide evidence-based, independent information and aims to support informed, shared decision making.”
