The Future of Anticoagulation

From a RAND Europe Research Report: The Future of Anticoagulation Initiative

From a RAND Europe Research Report

Atrial Fibrillation (AF)

• Is the most common type of sustained cardiac arrhythmia1 affecting approximately 1.5-2% of the developed world.2
• AF prevalence increases with age and it affects roughly 18% of the population over 85.3
• The total cost burden of AF in the EU is approximately €26-30bn.3
• By 2050 it is expected that in some European countries, nearly 40% of the population will be over 60.3
• AF prevalence among adults over 55 in the EU is expected to double from 8.8 to 17.9 million, between 2010 and 2060.1

Aims and Objectives

The report aims were to assess the current landscape and challenges for the management of AF in Europe, and explore how this landscape could evolve. It focused on six focus 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.

Research

Research included a comprehensive literature review supported by 60 key informant interviews with healthcare professionals, patient representatives, policymakers/influencers to assess the current landscape and future of AF.

Findings were analysed based on PESTLE factors (political, economic, social, technological, legal, environmental), and population trends.

This allowed the development and exploration of future scenarios, as well as short term and long term recommendations.

All of these activities were carried out with feedback and input from a Steering Committee made up of 10 experts in cardiology and related areas from the six European focus countries. The research focused on the role of anticoagulation for the prevention of AF-related stroke in six key European countries; Belgium, France, Germany, Italy, Spain and the UK.3

Approach and Methods

• Collate existing Reporting knowledge
• Design of potential futures
• Analysis of discussion around potential futures
• Reporting

• Rapid evidence assessment
• Key informant interviews
• Scenarios
• Engagement with sheering committee

The Future of Anticoagulation Initiative -- International Steering Committee

Representing professional and patient perspectives, the committee guided research, consideration of future scenarios and shaping of recommendations to improve the outlook for AF.3

Members

United Kingdom

• Prof John Camm (Chair)
• Trudie Lobban, AF Association
• Dr Jonathan Salter
• Dr Andrew Walker

Germany

• Prof Hans-Christoph Diener
• Prof Dr Andreas Goette
• Prof Reinhold Kreutz

France

• Prof Jean-Marc Davy

Italy

• Prof Raffaele De Caterina

Spain

• Prof Josep Brugada

Challenges

Immediate challenges3

1. Low awareness of AF and link to stroke risk, and difficulties securing funding for campaigns
2. Education of AF patients and HCPs
3. Integrating research and healthcare

Long term challenges3

1. Short-term spending dynamics associated with AF awareness, education, care and management
2. Diverse patient profiles in terms of comorbidities and social situations
3. Barriers to inter-professional exchange that make collaboration challenging
4. Using data effectively to benefit management of AF

Recommendations

Immediate recommendations3

1. Improve AF awareness among the public and policy makers
2. Support education about AF management for HCPs and patients
3. Maintain engagement in AF-related research across the health services

Long term recommendations3

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

The Future of Anticoagulation Initiative was funded by Daiichi Sankyo Europe

This infographic relates to work done by RAND Europe (www.rand.org/randeurope) for the Future of Anticoagulation Initiative funded by Daiichi Sankyo Europe and documented in The Future of anticoagulation management in atrial fibrillation in Europe. An assessment of today's challenges with recommendations for the future, by Catherine Lichten, Sophie Castle-Clarke, Catriona Manville, Veronika Horvath, Enora Robin, Joachim Krapels, Sarah Parks, Megan Sim, Olga van Zijverden and Joanna Chataway, RR-1053-UKRF, 2015. Further details about the project are available at www.rand.org/randeurope/research/projects/future-of-anticoagulation.html

1 Krijthe, B.P., et al. 2013. 'Projections on the number of individuals with atrial fibrillation in the European Union from 2000 to 2060.' European Heart Journal 34(35): 2746-51.

2 Camm, J.A., et al. 2012. '2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation.' European Heart Journal 33: 2719-47.

3 Lichten, C., Castle-Clarke, S., Manville, C., Horvath, V., Robin, E., Krapels, J., Parks, S., Sim, M., van Zijverden, O., Chataway, J. (2015). The future of anticoagulation management in atrial fibrillation in Europe: An assessment of today's challenges with recommendations for the future. Rand Corporation.

Date of preparation: May 2015

Job code: EDX/15/0081