{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:54:24Z","timestamp":1793404464192,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 107\u20132314-B-075\u2013062-MY3"],"award-info":[{"award-number":["MOST 107\u20132314-B-075\u2013062-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 108\u20132314-B-075\u2013022"],"award-info":[{"award-number":["MOST 108\u20132314-B-075\u2013022"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108B-015"],"award-info":[{"award-number":["V108B-015"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108B-027"],"award-info":[{"award-number":["V108B-027"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108C-090"],"award-info":[{"award-number":["V108C-090"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V109C-042"],"award-info":[{"award-number":["V109C-042"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V109C-186"],"award-info":[{"award-number":["V109C-186"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To analyse the temporal trends of oral anticoagulant (OAC) prescription, direct oral anticoagulant (DOAC) dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation (AF).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>During 1 January 2011\u201331 December 2020, a total of 249\u2009107 patients with newly diagnosed AF were identified, and the 1-year risks of ischaemic stroke, intracranial haemorrhage (ICH), and all-cause mortality were analysed. OAC prescription increased from 22.1% in 2011 to 57.7% in 2020 with DOAC accounting for 91.0% of overall OAC prescriptions. Compared to patients with incident AF diagnosed in 2011, there were increasing trends for a greater decrease in the risks of ischaemic stroke during 2012\u20132020 and mortality during 2014\u20132020, while the risk of ICH did not change significantly. For DOAC users, higher dose use increased from 11.04% in 2012 to 44.29% in 2019\u20132020 temporally associated with a lower risk of ischaemic stroke in the years 2015\u20132017 and 2018\u20132020 compared to 2012\u20132014. Determining factors refraining from OAC use included some \u2018patient-related factors\u2019 and \u2018non-patient\u2019 factors (AF diagnosed at clinics by physicians other than cardiologist\/neurologist\/internal medicine and citizens outside municipalities).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>There was an increasing trend of OAC prescription, temporally associated with a decreased risk of ischaemic stroke and mortality. Among DOACs users, the risk of ischaemic stroke declined gradually, partly explained by the increasing prescriptions of higher dose DOACs. Both patient and non-patient factors were associated with non-anticoagulation. Further efforts are required to increase OAC prescription.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf002","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T05:18:20Z","timestamp":1737609500000},"page":"300-311","source":"Crossref","is-referenced-by-count":9,"title":["Temporal trends of prescription rates, oral anticoagulants dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation"],"prefix":"10.1093","volume":"11","author":[{"given":"Jo-Nan","family":"Liao","sequence":"first","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1406-8503","authenticated-orcid":false,"given":"Yi-Hsin","family":"Chan","sequence":"additional","affiliation":[{"name":"Chang Gung Memorial Hospital The Cardiovascular Department, , Taoyuan 333 ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan 33302 ,","place":["Taiwan"]},{"name":"Microscopy Core Laboratory, Chang Gung Memorial Hospital , Taoyuan 333 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Kuo","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan-Tsai","family":"Tsai","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Min","family":"Liu","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8350-0232","authenticated-orcid":false,"given":"Tzeng-Ji","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Department of Family Medicine, , Taipei 11217 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool L69 7ZX ,","place":["UK"]},{"name":"Aalborg University Danish Center for Health Services Research, Department of Clinical Medicine, , Aalborg 9260 ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-5625","authenticated-orcid":false,"given":"Shih-Ann","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]},{"name":"Cardiovascular Center, Taichung Veterans General Hospital , Taichung 407219 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7461-2793","authenticated-orcid":false,"given":"Tze-Fan","family":"Chao","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital Division of Cardiology, Department of Medicine, , Shipai Rd., Taipei 11217 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University , Linong St., Taipei 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"2025050111115606500_bib1","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials","volume":"383","author":"Ruff","year":"2014","journal-title":"Lancet"},{"key":"2025050111115606500_bib2","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1161\/CIRCULATIONAHA.118.036046","article-title":"Evolving changes of the use of oral anticoagulants and outcomes in patients with newly diagnosed atrial fibrillation in Taiwan","volume":"138","author":"Chao","year":"2018","journal-title":"Circulation"},{"key":"2025050111115606500_bib3","doi-asserted-by":"crossref","first-page":"102039","DOI":"10.1016\/j.eclinm.2023.102039","article-title":"Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry","volume":"63","author":"Romiti","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2025050111115606500_bib4","doi-asserted-by":"crossref","first-page":"euad120","DOI":"10.1093\/europace\/euad120","article-title":"Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients without previous oral anticoagulants or stable under warfarin: a nationwide cohort study","volume":"25","author":"Liu","year":"2023","journal-title":"Europace"},{"key":"2025050111115606500_bib5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jacc.2017.10.085","article-title":"Relationship of aging and incident comorbidities to stroke risk in patients with atrial fibrillation","volume":"71","author":"Chao","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2025050111115606500_bib6","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.chest.2019.11.025","article-title":"Comparing the effectiveness and safety of nonvitamin K antagonist oral anticoagulants and Warfarin in elderly Asian patients with atrial fibrillation: a nationwide cohort study","volume":"157","author":"Chao","year":"2020","journal-title":"Chest"},{"key":"2025050111115606500_bib7","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1093\/eurheartj\/ehy837","article-title":"Age threshold for the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation: insights into the optimal assessment of age and incident comorbidities","volume":"40","author":"Chao","year":"2019","journal-title":"Eur Heart J"},{"key":"2025050111115606500_bib8","first-page":"157","article-title":"Accuracy of diabetes diagnosis in health insurance claims data in Taiwan","volume":"104","author":"Lin","year":"2005","journal-title":"J Formos Med Assoc"},{"key":"2025050111115606500_bib9","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/pds.2087","article-title":"Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan","volume":"20","author":"Cheng","year":"2011","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025050111115606500_bib10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.atherosclerosis.2013.11.036","article-title":"Continuation of statin therapy and a decreased risk of atrial fibrillation\/flutter in patients with and without chronic kidney disease","volume":"232","author":"Chang","year":"2014","journal-title":"Atherosclerosis"},{"key":"2025050111115606500_bib11","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"key":"2025050111115606500_bib12","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"key":"2025050111115606500_bib13","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jfma.2013.09.009","article-title":"Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database","volume":"114","author":"Hsieh","year":"2015","journal-title":"J Formos Med Assoc"},{"key":"2025050111115606500_bib14","doi-asserted-by":"crossref","first-page":"e000756","DOI":"10.1161\/JAHA.113.000756","article-title":"Atrial fibrillation, stroke, and anticoagulation in Medicare beneficiaries: trends by age, sex, and race, 1992-2010","volume":"3","author":"Shroff","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2025050111115606500_bib15","doi-asserted-by":"crossref","first-page":"e005155","DOI":"10.1161\/JAHA.116.005155","article-title":"Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care","volume":"6","author":"Lane","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025050111115606500_bib16","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1136\/heartjnl-2017-312930","article-title":"Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015","volume":"104","author":"Kim","year":"2018","journal-title":"Heart"},{"key":"2025050111115606500_bib17","doi-asserted-by":"crossref","first-page":"e2014874","DOI":"10.1001\/jamanetworkopen.2020.14874","article-title":"Trends in atrial fibrillation incidence rates within an integrated Health Care delivery system, 2006 to 2018","volume":"3","author":"Williams","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025050111115606500_bib18","doi-asserted-by":"crossref","first-page":"euad280","DOI":"10.1093\/europace\/euad280","article-title":"Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry","volume":"25","author":"Schnabel","year":"2023","journal-title":"Europace"},{"key":"2025050111115606500_bib19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jjcc.2019.01.001","article-title":"Real-world outcomes of the Xarelto Post-Authorization Safety & Effectiveness Study in Japanese patients with atrial fibrillation (XAPASS)","volume":"74","author":"Ikeda","year":"2019","journal-title":"J Cardiol"},{"key":"2025050111115606500_bib20","doi-asserted-by":"crossref","first-page":"5337","DOI":"10.3390\/jcm10225337","article-title":"Clinical events with Edoxaban in South Korean and Taiwanese atrial fibrillation patients in routine Clinical practice","volume":"10","author":"Choi","year":"2021","journal-title":"J Clin Med"},{"key":"2025050111115606500_bib21","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.3390\/jcm12051870","article-title":"Prescribing patterns and outcomes of Edoxaban in atrial fibrillation: one-year data from the Global ETNA-AF program","volume":"12","author":"Chao","year":"2023","journal-title":"J Clin Med"},{"key":"2025050111115606500_bib22","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ahj.2017.08.018","article-title":"Two-year follow-up of patients treated with dabigatran for stroke prevention in atrial fibrillation: global Registry on long-term antithrombotic treatment in patients with atrial fibrillation (GLORIA-AF) registry","volume":"198","author":"Huisman","year":"2018","journal-title":"Am Heart J"},{"key":"2025050111115606500_bib23","doi-asserted-by":"crossref","first-page":"euad302","DOI":"10.1093\/europace\/euad302","article-title":"Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF","volume":"25","author":"Guenoun","year":"2023","journal-title":"Europace"},{"key":"2025050111115606500_bib24","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2025050111115606500_bib25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 Focused update consensus guidelines of the Asia pacific heart rhythm society on stroke prevention in atrial fibrillation: executive summary","volume":"122","author":"Chao","year":"2022","journal-title":"Thromb Haemost"},{"key":"2025050111115606500_bib26","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/a-1515-9630","article-title":"Adherence to the \u2018atrial fibrillation better care\u2019 Pathway in patients with atrial fibrillation: impact on clinical outcomes-A systematic review and meta-analysis of 285,000 patients","volume":"122","author":"Romiti","year":"2022","journal-title":"Thromb Haemostasis"},{"key":"2025050111115606500_bib27","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1055\/s-0043-1769612","article-title":"Mobile health-technology-integrated care for atrial fibrillation: a win ratio analysis from the mAFA-II randomized clinical trial","volume":"123","author":"Romiti","year":"2023","journal-title":"Thromb Haemostasis"},{"key":"2025050111115606500_bib28","article-title":"Non-vitamin K antagonist oral anticoagulant, Warfarin, and ABC pathway adherence on hierarchical outcomes: win ratio analysis of the COOL-AF registry","volume":"124","author":"Treewaree","year":"2024","journal-title":"Thromb Haemostasis"},{"key":"2025050111115606500_bib29","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1161\/STROKEAHA.113.000990","article-title":"Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation","volume":"44","author":"Hori","year":"2013","journal-title":"Stroke"},{"key":"2025050111115606500_bib30","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1161\/STROKEAHA.113.002968","article-title":"Rivaroxaban for stroke prevention in East Asian patients from the ROCKET AF trial","volume":"45","author":"Wong","year":"2014","journal-title":"Stroke"},{"key":"2025050111115606500_bib31","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.ahj.2014.06.005","article-title":"Efficacy and safety of apixaban compared with warfarin for stroke prevention in patients with atrial fibrillation from East Asia: a subanalysis of the Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial","volume":"168","author":"Goto","year":"2014","journal-title":"Am Heart J"},{"key":"2025050111115606500_bib32","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1253\/circj.CJ-15-1082","article-title":"Edoxaban vs. Warfarin in East Asian patients with atrial fibrillation: an ENGAGE AF-TIMI 48 subanalysis","volume":"80","author":"Yamashita","year":"2016","journal-title":"Circ J"},{"key":"2025050111115606500_bib33","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1161\/CIRCULATIONAHA.117.031658","article-title":"Oral anticoagulation in very elderly patients with atrial fibrillation: a nationwide cohort study","volume":"138","author":"Chao","year":"2018","journal-title":"Circulation"},{"key":"2025050111115606500_bib34","doi-asserted-by":"crossref","first-page":"105474","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105474","article-title":"Emergency medicine physician attitudes toward anticoagulant initiation for patients with atrial fibrillation","volume":"30","author":"Hua","year":"2021","journal-title":"J Stroke Cerebrovasc Dis"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcaf002\/61564337\/qcaf002.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/3\/300\/61564337\/qcaf002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/3\/300\/61564337\/qcaf002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T15:12:13Z","timestamp":1746112333000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/11\/3\/300\/7973000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,1,22]]},"published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcaf002","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,1,22]]}}}