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Anticoagulation in atrial fibrillation

Consideration for treatment and health economic aspects
PhD ceremony:Ms M.S. (Maartje) Jacobs
When:September 30, 2020
Supervisor:prof. dr. M.J. (Maarten) Postma
Co-supervisors:dr. M. (René) van Hulst, dr. R. Tieleman
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Anticoagulation in atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increased risk of stroke and mortality. Effective stroke prevention leads to an improved quality of life and a lower economic disease burden. Anticoagulants such as the oral vitamin K antagonist and non-vitamin K antagonist oral anticoagulants can be used to reduce the stroke risk.In this thesis, Maartje Jacobs describes different aspects of AF treatment with a focus on stroke prevention. The research emphasizes on disease detection, drug treatment and how to handle specific subgroups. This thesis captures the aspects that are relevant from a clinical perspective as well as a payer’s and societal perspective.Important factors in stroke prevention are early detection of AF using screening, optimized prescription of the oral anticoagulants and appropriate use by the patient. Jacobs showed in this thesis that screening for AF can be a cost-effective, and even cost-saving, approach to detect new patients and to initiate stroke prevention. Specific subgroups would require a tailored approach for stroke prevention. Sub-populations with more challenges in AF treatment are for example critically ill patients, patients undergoing surgery and patients with co-existing coronary artery disease. Jacobs concludes that healthcare should be delivered in a way that best fits the patient, meaning: individualized treatment choices to optimize the AF risk management leading to improved patient outcomes. Since stroke induces a high economic burden to society, AF detection and stroke prevention are a good starting point for healthcare optimization.