Authors (including presenting author) :
Chen L(1) , Lee CP (2), Chan LP(1), Hui MT(2), Leung MKW(1)
Affiliation :
(1)Lek Yuen General Out-patient Clinic (2)Wong Siu Ching Family Medicine Centre
Introduction :
Anticoagulant is the most important modifiable factor to reduce stroke incidence in Atrial fibrillation(AF). Non-vitamin K antagonist oral anticoagulants(NOACs) are indicated to prevent stroke in patients with non-valvular AF by both the European Society of Cardiology and the American Heart Association guidelines. In order to promote the usage of the NOACs in AF patients, NOACs sponsorship was introduced to public general out-patient clinics (GOPCs) since 2019. The prescription of these NOACs was limited to patients with a high risk of stroke whose CHA2DS2-VASc score was 5 or more. There is still a great gap between guidelines and the clinical utilisation rate of NOACs. This study was conducted to evaluate the utilisation rate of NOAC, and the factors independently associated with NOAC refusal in AF patients, aim to identify the barriers to optimal NOAC use in the GOPC.
Objectives :
To evaluate the utilisation rate of NOAC and associated factors of NOAC refusal in AF patients
Methodology :
This cross sectional study was conducted in two GOPCs in Tai Po. All adult AF patients were invited to attend the Atrial Fibrillation Clinic (AFC) during November 2019 to March 2020. Study subjects were seen by the principal investigator, with active review of the clinical condition and discussion of the NOACs options. Exclusion criteria: 1) CHA2DS2-VASc Score =0 in male or CHA2DS2-VASc Score =1 in female; 2) Moderate-to-severe mitral stenosis; 3) Prosthetic valve or valve repair; 4) Child-Pugh category C hepatic insufficiency; 5) Severe renal failure with CrCl<15mL/min or on dialysis; 6) Clinically significant active bleeding; 7) HAS-BLED score16 ≧ 3 or history of non-traumatic intracranial hemorrhage; 8) Pregnancy or breastfeeding mother; 9) Current hospitalization or hospitalization within one month prior to inclusion in the study; 10) Allergy to NOACs; 11) Refusal to join the study or not competent to consent. Baseline demographic and clinical data was collected and recorded via a questionnaire and a review of the medical records. The following data was collected: (1) sociodemographic information including age, sex, education level, living condition, marital status, financial strain, employment status; (2) drinking and smoking habit; (3) any sponsor for NOACs; (4) duration of atrial fibrillation; (5) CHA2DS2-VASc component details; (6) NOAC use. Data was compared between the NOAC refusal group and non-refusal group. Binary logistic regression analysis was performed to identify factors significantly associated with the refusal of NOACs.
Result & Outcome :
A total of 324 patients were included during the study period. Utilisation rate of NOAC in AF patients was 54%. Multivariate analysis revealed that older age, higher financial strain score, lack of sponsor for NOAC and lower CHA2DS2-VASc score were the factors that were significantly associated with NOAC refusal.
