Reports

DOAC prescribing in people with a mechanical heart valve replacement

Description
Monthly DOAC prescribing count and rate in people coded as having a mechanical heart valve replacement
Authors
Louis Fisher, Victoria Speed, Helen J Curtis, Christopher T Rentsch, Angel YS Wong, Anna Schultze, Jon Massey, Peter Inglesby, Caroline E Morton, Marion Wood, Alex J Walker, Jessica Morley, Amir Mehrkar, Seb Bacon , George Hickman, Chris Bates, Richard Croker, David Evans, Tom Ward, Jonathan Cockburn, Simon Davy, Krishnan Bhaskaran, Becky Smith, Elizabeth Williamson, William Hulme, Amelia Green, Rosalind M Eggo, Harriet Forbes, John Tazare, John Parry, Frank Hester, Sam Harper, Jonathan Meadows, Shaun O’Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Ian J Douglas, Stephen JW Evans, Laurie Tomlinson, Brian MacKenna, Liam Smeeth, Ben Goldacre.
Contact
Get in touch and tell us how you use this report or new features you'd like to see: [email protected]
First published
07 Jul 2021
Last updated
27 Oct 2021

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2021. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.

Results

Monthly Count

The monthly number of DOAC prescriptions in people with a record of a mechanical valve.

Figure 1. The monthly number of people with a record of a mechanical valve who are also prescribed a DOAC between September 2019 and September 2021. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.

The monthly number of DOAC prescriptions in people with a record of a mechanical valve with mean value in the 6 months prior to and 6 months following advice on the safe switching of patients on warfarin to a DOAC in March 2020 shows an increase from 507 (95% C.I. = 489,525) to 557 (95% C.I. = 538,576) (9.9%).

Figure 2. The monthly number of people with a record of a mechanical valve who are also prescribed a DOAC between September 2019 and September 2021 with the mean value 6 months prior to and 6 months after the issuing of national anticoagulation switching guidance. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.

Monthly Rate

The monthly rate of DOAC prescribing per 1000 people with a record of a mechanical valve.

Figure 3. The monthly rate of people prescribed a DOAC per 1000 people with a record of a mechanical heart valve between September 2019 and September 2021. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.

DOAC prescribing in people with a mechanical heart valve replacement

Description
Monthly DOAC prescribing count and rate in people coded as having a mechanical heart valve replacement
Authors
Louis Fisher, Victoria Speed, Helen J Curtis, Christopher T Rentsch, Angel YS Wong, Anna Schultze, Jon Massey, Peter Inglesby, Caroline E Morton, Marion Wood, Alex J Walker, Jessica Morley, Amir Mehrkar, Seb Bacon , George Hickman, Chris Bates, Richard Croker, David Evans, Tom Ward, Jonathan Cockburn, Simon Davy, Krishnan Bhaskaran, Becky Smith, Elizabeth Williamson, William Hulme, Amelia Green, Rosalind M Eggo, Harriet Forbes, John Tazare, John Parry, Frank Hester, Sam Harper, Jonathan Meadows, Shaun O’Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Ian J Douglas, Stephen JW Evans, Laurie Tomlinson, Brian MacKenna, Liam Smeeth, Ben Goldacre.
Contact
Get in touch and tell us how you use this report or new features you'd like to see: [email protected]
First published
07 Jul 2021
Last updated
27 Oct 2021

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2021. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.

Results

Monthly Count

The monthly number of DOAC prescriptions in people with a record of a mechanical valve.

Figure 1. The monthly number of people with a record of a mechanical valve who are also prescribed a DOAC between September 2019 and September 2021. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.

The monthly number of DOAC prescriptions in people with a record of a mechanical valve with mean value in the 6 months prior to and 6 months following advice on the safe switching of patients on warfarin to a DOAC in March 2020 shows an increase from 507 (95% C.I. = 489,525) to 557 (95% C.I. = 538,576) (9.9%).

Figure 2. The monthly number of people with a record of a mechanical valve who are also prescribed a DOAC between September 2019 and September 2021 with the mean value 6 months prior to and 6 months after the issuing of national anticoagulation switching guidance. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.

Monthly Rate

The monthly rate of DOAC prescribing per 1000 people with a record of a mechanical valve.

Figure 3. The monthly rate of people prescribed a DOAC per 1000 people with a record of a mechanical heart valve between September 2019 and September 2021. *Figure updated on 27-10-21 to include data for 06-21 - 09-21.