Title : Prevalence of direct oral anticoagulant use in atrial fibrillation patients in a CKD clinic
Abstract:
Background: Chronic kidney disease affects a significant proportion of the UK population and is associated with cardiovascular risk factors such as hypertension and diabetes mellitus. Many patients with CKD present with Atrial fibrillation, which also increases the risk for a cardiovascular event. NICE guidelines were recently updated with the recommendation of CKD patients with comorbid AF being anticoagulated with direct oral anticoagulants, instead of vitamin K antagonists as was previously advised. It is recommended to offer anticoagulation with a DOAC to patients with AF and a CHA2DS2-VASc score of 2 or above, considering the risk of bleeding.
Method: A study was undertaken at Heartlands Hospital, Birmingham which looked at all patients with Chronic kidney disease that initially presented to the CKD clinic between 2010 and 2018. The exclusion criteria involved patients that did not have an ECG at their initial consultation. Data was analysed using excel to determine how many CKD patients had AF, and which anticoagulants were utilised.
Results: The ECG rhythm for the population group showed 86% for Sinus Rhythm, 9% for AF, 3% for Pacemaker Rhythm, 2% for Unknown and <1% for Other. The proportion of the type of anticoagulant used in patients with AF were also recorded as followed: Aspirin with 54%, Losartan with 28%, Warfarin 10%, Apixaban 5%, Rivaroxaban 2% and Edoxaban 1%. Overall, 134 of the 188 (71.3%) patients with AF were anticoagulated using any anticoagulant. Of these, only 11 (8.2%) were anticoagulated with a DOAC as per NICE guidelines. Patients with CKD and comorbid AF only had 5.9% of them taking direct oral anticoagulants. 28.7% of patients were not on any anticoagulation.
Conclusion: This project has highlighted that only 5.9% of patients with CKD and comorbid AF are being anticoagulated using DOACs. In contrast, 65.4% of patients were anticoagulated with VKAs, which is now outdated practice. Therefore, we have highlighted that there are several improvements to be made within CKD clinics with regards to staff education, and increased use of DOACs in preference to VKAs.
