ArticleHeart (British Cardiac Society)2021
Clinical and budget impacts of changes in oral anticoagulation prescribing for atrial fibrillation.
Article in Heart (British Cardiac Society), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 31 citations in OpenAlex.
- Clinical outcomes in patients with atrial fibrillation and frailty: insights from the ENGAGE AF-TIMI 48 trial.BMC medicine · 2020Trial
- Evaluating the impact of a structured medication optimisation review on prescribing patterns and bleeding risk among patients prescribed direct oral anticoagulants (DOACs): a difference-in-differences study.BMJ open quality · 2025Article
- Article
- Article
- Temporal trends of cause-specific mortality after diagnosis of atrial fibrillation.European heart journal · 2023Article
- Drug-Associated Gastropathy: Diagnostic Criteria.Diagnostics (Basel, Switzerland) · 2023Review
- Article
- Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands.JAMA network open · 2023Article
- Effectiveness of Hemopatch® versus Surgicel® Original to control mild and moderate liver bleeding.BMC surgery · 2022Article
- Acute Upper Gastrointestinal Bleeding: Less Severe Bleeding in More Frail and Older Patients, Comparison Between Two Time Periods Fifteen Years Apart.Gastroenterology research · 2022Article
- Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation.European heart journal supplements : journal of the European Society of Cardiology · 2022Article
- Why translation from basic discoveries to clinical applications is so difficult for atrial fibrillation and possible approaches to improving it.Cardiovascular research · 2021Review
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess temporal clinical and budget impacts of changes in atrial fibrillation (AF)-related prescribing in England.
methodsData on AF prevalence, AF-related stroke incidence and prescribing for all National Health Service general practices, hospitals and registered patients with hospitalised AF-related stroke in England were obtained from national databases. Stroke care costs were based on published data. We compared changes in oral anticoagulation prescribing (warfarin or direct oral anticoagulants (DOACs)), incidence of hospitalised AF-related stroke, and associated overall and per-patient costs in the periods January 2011-June 2014 and July 2014-December 2017.
resultsBetween 2011-2014 and 2014-2017, recipients of oral anticoagulation for AF increased by 86.5% from 1 381 170 to 2 575 669. The number of patients prescribed warfarin grew by 16.1% from 1 313 544 to 1 525 674 and those taking DOACs by 1452.7% from 67 626 to 1 049 995. Prescribed items increased by 5.9% for warfarin (95% CI 2.9% to 8.9%) but by 2004.8% for DOACs (95% CI 1848.8% to 2160.7%). Oral anticoagulation prescription cost rose overall by 781.2%, from £87 313 310 to £769 444 028, (£733,466,204 with warfarin monitoring) and per patient by 50.7%, from £293 to £442, giving an incremental cost of £149. Nevertheless, as AF-related stroke incidence fell by 11.3% (95% CI -11.5% to -11.1%) from 86 467 in 2011-2014 to 76 730 in 2014-2017 with adjustment for AF prevalence, the overall per-patient cost reduced from £1129 to £840, giving an incremental per-patient saving of £289.
conclusionsDespite nearly one million additional DOAC prescriptions and substantial associated spending in the latter part of this study, the decline in AF-related stroke led to incremental savings at the national level.
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