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. 2025 Mar 1:57:101639.
doi: 10.1016/j.ijcha.2025.101639. eCollection 2025 Apr.

Characterization and anticoagulation treatment patterns of hospitalized patients with nonvalvular atrial fibrillation in Spain: The CARISMA registry

Lorenzo Fácila  1   2 , Alberto Cordero  3 , Adrián Valverde Tavira  1 , Irene Rilo Miranda  4 , Alain Laskibar Asua  5 , Laia Tirapu  6 , Vicente Montagud  1 , Juan Sánchez-Serna  7 , Eloy Gómez-Mariscal  8 , Luis Mainar  9 , Ernesto Martín Dorado  10 , Natalia Lorenzo  11 , Ana María Pello Lázaro  12 , Moisés Rodríguez-Mañero  13   14   15
Affiliations

Characterization and anticoagulation treatment patterns of hospitalized patients with nonvalvular atrial fibrillation in Spain: The CARISMA registry

Lorenzo Fácila et al. Int J Cardiol Heart Vasc. .

Abstract

Background: This study described the clinical and demographic characteristics of hospitalized patients with nonvalvular atrial fibrillation (NVAF) and prescriptions for vitamin-K antagonists (VKA) and direct-acting oral anticoagulants (DOAC) in Spain.

Methods: This was an observational, multicentric, retrospective study of patients treated with DOAC or VKA due to NVAF at cardiology services of hospitals in Spain. A registry (CARISMA) included patients hospitalized for any reason and discharged before July 1st, 2021, with a prescription for DOAC or VKA. Data was collected on demographic and clinical characteristics and anticoagulant treatments prescribed. Analyses were descriptive.

Results: A total of 1,041 patients were included. Mean age (SD) was 77.2 (10.3) years and 57.6 % were men. The most frequent reason for hospital admission was heart failure (43.8 %) and arrhythmias (25.0 %). The mean (SD) CHA2DS2-VASc score was 4.0 (1.6). Prior to admission, 75.6 % of patients had been prescribed anticoagulant treatment for NVAF. Of these, 56.0 % had received VKA and 44.0 % DOAC. At discharge, 60 % had a DOAC prescription (of these, apixaban, 37.6 %; edoxaban, 26.4 %; rivaroxaban, 25.1 %; dabigatran, 10.9 %) and 40 % a VKA. DOAC prescriptions were off-label with respect to dosing in 19-34 % of cases. Patients with off-label dosing were older and with a higher proportion of women than those with on-label doses. During hospitalization, 12.1 % of patients changed treatment, usually VKA to DOAC.

Conclusion: Before hospitalization, a quarter of patients with NVAF were not receiving anticoagulation medication. Hospitalization increased the proportion of patients receiving DOAC, but about a quarter of patients had off-label dosing prescriptions.

Keywords: Acenocoumarin; Arrhythmias; Direct acting oral anticoagulant; Hospitalization; Nonvalvular atrial fibrillation; Vitamin-K antagonists.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors reports administrative support, article publishing charges, and writing assistance were provided by Daiichi Sankyo Spain, S.A.U. L. Facila reports a relationship with AstraZeneca, AMGEN, Bristol-Myers Squibb, Ferrer, Bayer, Organon, Daiichi Sankyo, Novartis, Novo Nordisk, Sanofi and Amarin that includes: consulting or advisory and speaking and lecture fees. A. Cordero reports a relationship with AstraZeneca, AMGEN, Bristol-Myers Squibb, Ferrer, Boehringer Ingelheim, MSD, Daiichy Sankio, Novartis, Novo Nordisk, Lilly, Sanofi and Amarin that includes: consulting or advisory and speaking and lecture fees. I. Rilo Miranda reports a relationship with Rovi, Novartis, Boehringer Ingelheim España, Sanofi Aventis, Bristol Myers Squibb, Astrazeneca, Almirall, Servier, and Organón Salud that includes: consulting or advisory. V. Montagud reports a relationship with Astrazeneca Farmaceutica Spain SA, Sanofi, Daiichi Sankyo and Bayer that includes: consulting or advisory. L. Mainar reports a relationship with Pfizer, Daiichi Sankyo, AstraZeneca, Boehringer-Lilly, Rovi and Novartis that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Patient disposition. Abbreviations: DOAC, direct-acting oral anticoagulants; VKA, vitamin K antagonists.
Fig. 2
Fig. 2
Oral anticoagulant treatment before admission (A), and at discharge (B).
See this image and copyright information in PMC

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