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Published on: February 26, 2013
Anticoagulant Use in High Stroke-Risk Patients With Nonvalvular Atrial Fibrillation
Hannah K Nguyen1, Douglas Humber1, Harvey Checkoway1
1<aff id="tcp-33-09-521-aff-001">A 2018 PharmD candidate, University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California at the time of this writing.
Insights
Oral anticoagulant (OAC) use in nonvalvular atrial fibrillation (NVAF) patients remains low, with less than 33% receiving treatment within 60 days. OAC uptake increased over time but remained below 53% by study end.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Oral anticoagulants (OACs) are crucial for managing stroke risk in nonvalvular atrial fibrillation (NVAF) patients.
- Current guidelines recommend OACs for NVAF patients with moderate-to-high stroke risk.
Purpose of the Study:
- To analyze the longitudinal patterns of OAC usage in incident NVAF patients.
- To assess the proportion of high-risk NVAF patients receiving OACs post-diagnosis.
Main Methods:
- Retrospective cohort analysis of 52,465 Medicare beneficiaries diagnosed with NVAF in 2010.
- Stroke risk assessed using the CHA2DS2-VASc score.
- OAC prescription rates were tracked over a three-year period.
Main Results:
- Only 32.7% of high-risk NVAF patients received OACs within 60 days of diagnosis in 2010.
- OAC utilization increased to 48% by the end of 2011 and 52.9% by the end of 2012.
- OAC use decreased in patients with higher CHA2DS2-VASc scores (greater than 6).
Conclusions:
- Initial OAC uptake in high-risk NVAF patients is suboptimal.
- Despite improvements, OAC use falls short of recommended levels.
- Targeted interventions are needed to increase OAC prescription rates, especially in high-risk individuals.
Abstract:
Background Oral anticoagulants (OACs) are recommended for nonvalvular atrial fibrillation (NVAF) patients with moderate-to high-stroke risk. Objective To examine nationally reflective OAC usage in incident NVAF patients longitudinally. Design Three-year retrospective cohort analysis. Setting Medicare Part D recipients in the contiguous United States.
Participants:
52,465 Medicare beneficiaries with incident NVAF in 2010 with two or more atrial fibrillation diagnoses seven or more days apart. Main outcome measure Stroke risk via congestive heart failure, hypertension, age greater than or equal to 75, diabetes, stroke, vascular disease, age 65-74, sex category (CHA2DS2-VASc) score. Primary outcome was proportion of patients receiving one or more OACs post-NVAF diagnoses. Results Of 48,980 high-risk patients, 32.7% received one or more OAC within 60 days of diagnosis. By close of 2011, 48% had one or more OAC. OAC use increased to 52.9% by close of 2012. Conclusions Fewer than 33% of high-risk NVAF patients received OACs within 60 days of diagnosis in 2010. Despite increased use over time, oral anticoagulation was below 53% at study end. Use of OACs declined with CHA2DS2-VASc greater than 6. Expanded efforts are warranted to augment OAC use in high stroke-risk patients.
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