Trends in Prevalence of Non-Valvular Atrial Fibrillation and Anticoagulation Therapy in a Japanese Region　- Analysis Using the National Health Insurance Database.
BACKGROUND
Direct oral anticoagulants (DOACs) are effective in reducing thromboembolism events in patients with non-valvular atrial fibrillation (NVAF). However, little is known about trends in NVAF prevalence and DOAC prescriptions in daily clinical practice. This study investigated the current status and trends in NVAF prevalence and DOAC prescriptions in a region of Japan.Methods and Results:Annual data for the 4 years from May 2014 to May 2017 in the Tsugaru region of Aomori Prefecture, Japan, were obtained for analysis from the Japanese National Health Insurance database ("Kokuho" database [KDB]). The prevalence of NVAF in subjects aged 40-74 years increased gradually over the 4-year study period (1,094/57,452 [1.90%] in 2014, 1,055/56,018 [1.88%] in 2015, 1,072/54,256 [1.98%] in 2016, and 1,154/52,341 [2.20%] in 2017). The proportion of NVAF patients prescribed warfarin decreased (42%, 33%, 24%, and 21% in 2014, 2015, 2016, and 2017, respectively), the proportion of those prescribed DOACs increased (30%, 42%, 50%, and 57%, respectively), and the proportion not prescribed an oral anticoagulant (OAC) decreased (28%, 25%, 26%, and 22%, respectively). However, 17% of patients with a CHADS2score ≥2 were not prescribed an OAC in 2017.


CONCLUSIONS
By using the KDB we found that the prevalence of NVAF has increased gradually from 2014 to 2017. In the Tsugaru region in Japan, DOACs prescriptions increased and warfarin prescriptions decreased over the 4-year period.
['Narita|Noritomo|N|', 'Okumura|Ken|K|', 'Kinjo|Takahiko|T|', 'Mikami|Joko|J|', 'Tsushima|Katsuko|K|', 'Takahashi|Reiko|R|', 'Noro|Makiko|M|', 'Hashimoto|Ayaka|A|', 'Sasaki|Teiko|T|', 'Takaki|Misaki|M|', 'Ishidoya|Emiko|E|', 'Narita|Yurika|Y|', 'Imai|Hideno|H|', 'Ono|Emiko|E|', 'Tomita|Hirofumi|H|']
D000284:Administration, Oral D000328:Adult D000368:Aged D000925:Anticoagulants D001281:Atrial Fibrillation D003430:Cross-Sectional Studies D016208:Databases, Factual D011307:Drug Prescriptions D017723:Drug Utilization Review D065427:Factor Xa Inhibitors D005260:Female D006801:Humans D007564:Japan D008297:Male D008875:Middle Aged D009313:National Health Programs D010818:Practice Patterns, Physicians' D015995:Prevalence D012189:Retrospective Studies D012307:Risk Factors D020521:Stroke D013997:Time Factors D016896:Treatment Outcome D014859:Warfarin
Direct oral anticoagulant Warfarin Kokuho database