Current Anticoagulation Statuses among Older Chinese People with Nonvalvular Atrial Fibrillation

Abstract

Background : The reported anticoagulation rate may be overestimated among Chinese patients with atrial fibrillation (AF). Therefore, we aimed to understand the current status and time trends of anticoagulation among older people in the Chinese community. Methods : Data were obtained from the physical examination program for the elderly (aged ≥ 65 years) in Guangzhou. During 2017–2020, a total of 31,829, 58,573, 55,483, and 54,845 older people underwent annual physical examinations, respectively, where their general information, AF-related medical history, and use of oral anticoagulants (OACs) were collected for analysis. Results : From 2017 to 2020, the estimated annual prevalence of older people with nonvalvular atrial fibrillation (NVAF) in Guangzhou was 0.99%, 0.92%, 1.05%, and 1.14%, respectively. In patients with high stroke risk (CHA2DS2-VASc score ≥ 2 for males or ≥ 3 for females), the annual anticoagulation rates were 2.83%, 2.05%, 5.29%, and 5.82%, respectively. The proportion of NVAF patients prescribed non-vitamin K antagonist oral anticoagulants (NOACs) increased gradually over the same period ( p = 0.004). Males (odds ratios (OR), 1.797; 95% confidence interval (CI), 1.169–2.763; p = 0.008), ages over 75 (OR, 1.858; 95% CI, 1.212–2.849; p = 0.005), low education levels (OR, 1.737; 95% CI, 1.132–2.665; p = 0.011), and lacking the ability for self-care (OR, 4.432; 95% CI, 1.067–18.418; p = 0.041) were less likely to receive OAC therapy. Conclusions : The low anticoagulation rate of older people with NVAF in the Chinese community has not significantly improved in recent years, with only 5.82% of patients with high stroke risk being prescribed OACs. Therefore, it is necessary to establish an appropriate mode of anticoagulant management to improve the current situation.