Diagnosis and Treatment Journey of Patients With Atrial Fibrillation Prior to Stroke Occurrence
Author(s)
Amiee Kang, MPH1, Ellen O'Brien, PhD2, Dimitra Lambrelli, MPharm, PhD3, Sandy Maumus-Robert, PharmD, PhD4, Achim Wolf, MSc5, Alyshah Abdul Sultan, PhD6, Ricardo Garcia Sanchez, MD1, Gregory Lip, MD7;
1Bristol Myers Squibb, Princeton, NJ, USA, 2Janssen Global Services, LLC, a Johnson & Johnson Company, Horsham, PA, USA, 3Evidera, Kalamaria, Greece, 4Evidera, Bordeaux, France, 5Evidera, London, United Kingdom, 6Janssen Pharmaceuticals, LLC, a Johnson & Johnson Company, Raritan, NJ, USA, 7Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
1Bristol Myers Squibb, Princeton, NJ, USA, 2Janssen Global Services, LLC, a Johnson & Johnson Company, Horsham, PA, USA, 3Evidera, Kalamaria, Greece, 4Evidera, Bordeaux, France, 5Evidera, London, United Kingdom, 6Janssen Pharmaceuticals, LLC, a Johnson & Johnson Company, Raritan, NJ, USA, 7Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Presentation Documents
OBJECTIVES: Atrial fibrillation (AF) prevalence is increasing with the aging population. AF increases the risk of stroke/systemic embolism (SE), and guidelines recommend oral anticoagulants (OAC) to reduce this risk. Nevertheless, some patients are not diagnosed on time or treated per guideline recommendations. This study described characteristics and treatment patterns of patients with AF.
METHODS: This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics Admitted Patient Care data and Office for National Statistics mortality data. The study spanned from January 2012-December 2021; the index date was the initial AF diagnosis date. Patients were categorized by timing of the AF diagnosis and OAC treatment pattern.
RESULTS: 312,879 patients with AF were identified, of whom, 38,233 (12.2%) experienced a stroke/SE, while 14,706 (4.7%) had an AF diagnosis either on or after the stroke event. Of patients with AF diagnosed before the stroke event (N=23,527), the average age was 78 years, average CHADs-VASc score and HAS-BLED score were 4.0 and 3.4, respectively. Approximately 28.2% of these patients had stage ≥3 chronic kidney disease; 37.7% had a history of bleeding. 11,205 (47.6%) received OAC treatments (first treatment: 58.6% on DOAC; 41.4% on warfarin); 2,057 (18.4%) of the OAC-treated patients discontinued treatment prior to their stroke. 12,322 (52.4%) patients did not receive OAC. The median duration from AF diagnosis to a stroke event was 823 days (IQR 353-1,472) for treated patients and 304 days (IQR 50-867) for untreated patients. For those who discontinued treatments, the median time from discontinuation to stroke event was 248 days (IQR 54-674).
CONCLUSIONS: Despite available OAC therapies, no treatment and treatment discontinuation are prevalent among patients with AF. These patients had a greater risk of stroke suggesting a potential opportunity for treatments with an improved benefit-risk profile and better persistence.
METHODS: This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics Admitted Patient Care data and Office for National Statistics mortality data. The study spanned from January 2012-December 2021; the index date was the initial AF diagnosis date. Patients were categorized by timing of the AF diagnosis and OAC treatment pattern.
RESULTS: 312,879 patients with AF were identified, of whom, 38,233 (12.2%) experienced a stroke/SE, while 14,706 (4.7%) had an AF diagnosis either on or after the stroke event. Of patients with AF diagnosed before the stroke event (N=23,527), the average age was 78 years, average CHADs-VASc score and HAS-BLED score were 4.0 and 3.4, respectively. Approximately 28.2% of these patients had stage ≥3 chronic kidney disease; 37.7% had a history of bleeding. 11,205 (47.6%) received OAC treatments (first treatment: 58.6% on DOAC; 41.4% on warfarin); 2,057 (18.4%) of the OAC-treated patients discontinued treatment prior to their stroke. 12,322 (52.4%) patients did not receive OAC. The median duration from AF diagnosis to a stroke event was 823 days (IQR 353-1,472) for treated patients and 304 days (IQR 50-867) for untreated patients. For those who discontinued treatments, the median time from discontinuation to stroke event was 248 days (IQR 54-674).
CONCLUSIONS: Despite available OAC therapies, no treatment and treatment discontinuation are prevalent among patients with AF. These patients had a greater risk of stroke suggesting a potential opportunity for treatments with an improved benefit-risk profile and better persistence.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD49
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)