Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The nationwide effect of significant changes in the rate of oral anticoagulation (OAC) on stroke rate of AF patients in the recent years is still unknown.
Hypothesis: Our aim was to investigate whether the advances in the field of AF management including wider utilization of non-vitamin K antagonist oral anticoagulants (NOAC) was related with improved time-trends for stroke for AF.
Methods: Between January, 2010 and December, 2015, we identified 629,102 patients with nonvalvular AF in the Korea National Health Insurance system (NHIS) database. Time-trends in annual stroke rates were analyzed. Particularly, NOACs were partially and fully reimbursed by Korea national insurance system in January 2013 and July 2015, respectively.
Results: The annual rate of anticoagulation increased by 63.7% from 14.6% (95%CI 0.145-0.147) in 2010 to 23.9% (95%CI 0.238-0.240) in 2015 (P for trend < 0.001) among eligible AF patients. After the reimbursement of NOAC in January 2013, the rate of overall OAC usage was increased by 49.4% (from 16.0% to 23.9%) despite the decreased use of vitamin K antagonist (from 16.2% to 13.7%). Rates of OAC use had significant inverse correlations with stroke rates (Pearson’s r = -0.90, p<0.001). The annual rate of stroke decreased from 4.02% in 2010 to 3.34% in 2012 (before the reimbursement of NOAC) and to 2.67% in 2015 (p for trend < 0.001). The rate of decline from 2013 through 2015 (4.18%±0.87%) was significantly greater (p<0.001) than the previous periods (from 2010 to 2012, 3.15%±3.06%).
Conclusions: Time-trends for the incidence of stroke among Korean AF patients show a decrease in recent years. The induction and the reimbursement of NOACs by national insurance system contribute to the increase of anticoagulation rate and consequently, decrease in stroke rate.