Atrial fibrillation (AF) affects up to 400,000 Australians and significantly increases the risk of ischaemic strokes, which are usually more severe than those from other causes. The overall cost of AF was estimated to be potentially $1.8 billion in 2010.

Applications for extended listing of new oral anticoagulants (NOACs) on the PBS prompted the Government to commission the Review of Anticoagulation Therapies in Atrial Fibrillation to identify options for improving the health of these patients.

The published review makes 15 recommendations around developing and implementing:

    • Inaugural national guidelines for detection and management including detailed strategies for optimising anticoagulant therapy;
    • Programs to increase awareness of both AF and its management for patients and health professionals using a broad range of convenient formats;
    • Standards for hospital accreditation to ensure patients commenced on warfarin are being included in programs to improve outcomes and minimise risks;
    • Further research and analysis of the risks and benefits of all available therapies; and
    • Improved warfarin management through education, dietary controls of vitamin K, point-of-care INR testing, tracking, and follow-up using a new multidisciplinary approach which will benefit from shared access to e-health records.

It is important to note that the review observes that NOACs only offer benefits for the 20% of patients who are unable to take warfarin. It invests strongly in warfarin as the drug of choice in producing a 65% reduction of strokes in AF patients, despite the many recognised ‘barriers’ to its use. This investment by the reviewers is not because of differences in efficacy between warfarin and NOACs, but rather that the use of NOACs is seen as even more problematic at this time.

References:

 

  1. Sansom L. Review of anticoagulation therapies in atrial fibrillation. Department of Health and Ageing. October 2012.
  2. PricewaterhouseCoopers. The economic costs of atrial fibrillation in Australia. National Stroke Foundation. June 2010.