The Future of Anticoagulation for Management of Atrial Fibrillation

Background

The heart arrhythmia atrial fibrillation (AF) is a widespread condition that is more common in elderly patients and brings an increased risk of stroke. AF management is complicated by a number of factors including high numbers of undiagnosed patients, and varying understanding of the disease among healthcare professionals and patients.

These issues, combined with the complex web of treatment protocols and reimbursement regimes in Europe, make it difficult to know what will be the most effective approaches for addressing the increasing public burden posed by AF. As populations age, AF is becoming increasingly prevalent.

Aims and Goals

This project set out to assess the current landscape and challenges for the management of AF in Europe, and explore how this landscape could evolve, focusing on six countries in Europe: Belgium, France, Germany, Italy, Spain and the UK. The two main goals of the study were to:

  1. Develop an evidence-base on the current reality of AF-related anticoagulation management in these six countries
  2. Develop an understanding of actions that could be taken today to improve the outlook for future AF management

Methods

The research was guided by a steering committee made up of experts in cardiology and other areas from across Europe. The study consisted of:

  • A comprehensive literature review and a rapid evidence assessment
  • 60 key informant interviews with healthcare professionals, patient representatives and policymakers / influencers

Findings

As for many chronic conditions, in the context of AF, there is a need to promote general cardiovascular health and increase awareness and education about the condition. In addition, as new therapies have become available (e.g. new oral anticoagulants in the case of AF), there has been uneven adoption across different parts of the health system. Prescribing behaviours and rules on reimbursement do not always reflect clinical guidance and emerging evidence. Finally, many patients with AF have a multiple health issues, creating challenges for AF management.

Several issues set AF apart from some other chronic conditions. As many AF patients are asymptomatic, they do not know that they have the condition, which means that many go undiagnosed until they have a stroke or symptoms develop. And patients on anticoagulation drugs may not feel different when on the drugs and so patients may be less likely to comply with drug regimes.

Recommendations

Short-term:

  • Improve AF awareness among the public and policymakers
  • Support education about AF management for HCPs and patients
  • Maintain engagement in AF-related research across the health services

Longer-term:

  • A longer-term view in decisions on spending for AF awareness, education, care and management is important for improving health outcomes
  • There is a need for continued improvement in patient stratification and personalisation of care
  • Increased interaction among primary, community, secondary and tertiary care would enable knowledge sharing and more whole-patient approaches to care
  • Monitor developments in devices and data to maximise benefits for AF management

Project Team

Catherine Lichten
Sophie Castle Clarke
Catriona Manville
Sarah Parks
Veronika Horvath
Enora Robin
Joachim Krapels
Megan Sim
Olga van Zijverden
Joanna Chataway