Strengths and limitations
This was the first AF study conducted using MedicineInsight dataset, which provided a large and national study population and thus enabled an more complete description of the GP prescribing of OACs in Australia (Gonzalez-Chica, Vanlint, Hoon & Stocks, 2018; MedicineInsight, 2018; Radford et al., 2018). Furthermore, ten-year sequential cross-sectional analyses enabled characterising the longitudinal trends in OAC prescribing.
The study has several limitations. The MedicineInsight dataset contains only records of medications prescribed by general practitioners. However, general practitioners in Australia typically continue those medications prescribed by cardiologists and so the trends described in this study may still be considered accurate and useful with regard to overall OAC prescribing. We did not account for medication contraindications and adverse drug reactions that may have prevented general practitioners from prescribing an OAC.
In this study, we used the guidelines retrospectively. For instance, before 2012, OAC treatment was recommended for patients at moderate to high stroke risk, and aspirin was widely used for patients at low stroke risk (Camm et al., 2010). However, the guidelines used for this analysis were in use for most of the study period and are appropriate to evaluate the trends.