RT Journal Article
SR Electronic
T1 General practice-related variation in oral anticoagulant treatment of atrial fibrillation: a nationwide cohort study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2024.0197
DO 10.3399/BJGPO.2024.0197
VO 9
IS 2
A1 Laugesen, Ina Grønkjær
A1 Vestergaard, Claus Høstrup
A1 Paust, Amanda
A1 Bro, Flemming
A1 Grove, Erik Lerkevang
A1 Prior, Anders
YR 2025
UL http://bjgpopen.org/content/9/2/BJGPO.2024.0197.abstract
AB Background Guideline-adherent oral anticoagulant (OAC) treatment in atrial fibrillation (AF) remains a challenge. In Denmark, most patients with AF are treated in general practice. Nevertheless, determinants of OAC prescription in primary care are poorly understood.Aim To investigate variation in OAC treatment adherence between general practice clinics and to identify clinic characteristics associated with a lower propensity to prescribe OAC treatment.Design & setting Nationwide register-based cohort study including prevalent and incident patients with AF and CHA2DS2-VASc score ≥2 (n = 165 731) listed with Danish general practice clinics (n = 1666) in 2021.Method The main outcome was OAC treatment adherence assessed as proportion of days covered (PDC). We used clinic OAC propensity to evaluate variation. OAC propensity was quantified as ratios between observed and expected adherence. Expected adherence was estimated based on the composition of the clinic patient populations. Sampled reference populations were constructed to account for random variation. Linear regression models examined associations between OAC propensity and clinic characteristics.Results The PDC with OAC treatment in the AF population was 78%. OAC propensity in clinics in the 90th percentile was 20% higher compared with clinics in the 10th percentile; however, this difference was reduced to 3% when accounting for random variation. Modest associations were observed between clinic characteristics and OAC propensity. The most significant difference was in the correlation between geographic location and OAC propensity, showing an 8% gap between top and bottom-performing regions.Conclusion The study suggests persistent underutilisation of OAC treatment in patients with AF and little variation in OAC prescription patterns across general practice clinics.