Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention
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Date
2020-01-03
Authors
Murphy, Aileen
Kirby, Ann
Bradley, Colin
Journal Title
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Publisher
Springer
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Abstract
Background: Direct oral anticoagulants (DOACs) are widely marketed as medicines that do not require routine laboratory monitoring. However, they do have complex pharmacological properties and side effects; hence prescribing and monitoring guidelines, such as the European Heart Rhythm Association (EHRA) guidelines, have emerged. These advocate monitoring for renal and hepatic impairment; bleeding episodes; liver function; co-medication; circulation, and occurrence of side effects. Though 3 to 6 month follow-up is advocated, this is currently not routine, and its implementation creates a potential obligation for general practitioners (GPs) managing atrial fibrillation (AF) patients in the community.
Aims: This study investigates the frequency, the type of follow-up, and the factors that influenced follow-up among Irish GPs, who prescribed DOACs to patients with AF, to prevent strokes in 2015.
Methods: The frequency and type of follow-up care is estimated, and a count model regression analysis is applied to determine the GP and practice characteristics that are associated with the implementation of follow-up.
Results: The EHRA guidelines most frequently followed were those pertaining to renal function (82%), bleeding episodes (71%), liver function (69%), circulation (54%), and side effects (55%). The regression analysis revealed that female GPs (P = 0.05) and GPs who follow all seven guidelines (P = 0.06) practice more frequent follow-up while those in training practices (P = 0.09) provide less frequent follow-up.
Conclusions: Results show that there was incomplete adherence to the 2013 EHRA prescribing guidelines with only 24% adhering to all seven guidelines, and patient follow-up was less frequent than has been suggested.
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Keywords
Adherence , Anticoagulation , Follow-up care , GP prescribing
Citation
Murphy, A., Kirby, A. and Bradley, C. (2020) ‘Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention’, Irish Journal of Medical Science (1971 -), 189(3), pp. 961–966. Available at: https://doi.org/10.1007/s11845-019-02150-0
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Copyright
© Royal Academy of Medicine in Ireland 2019. This version of the article has been accepted for publication, after peer review and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s11845-019-02150-0