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Updated: Jun 30, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health
William Hirschfeld1, Richele Corrado1, Amanda Banaag2,3
1Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Direct oral anticoagulants (DOACs) are a first-line treatment for atrial fibrillation. This study found disparities in DOAC prescription within the Military Health System based on race, gender, and socioeconomic status.
Area of Science:
- Cardiology
- Health Services Research
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are a cornerstone of anticoagulant therapy for patients diagnosed with atrial fibrillation.
- Understanding prescribing patterns within specific healthcare systems, such as the Military Health System (MHS), is crucial for ensuring equitable patient care.
Purpose of the Study:
- To investigate prescribing variations of direct oral anticoagulants (DOACs) among eligible atrial fibrillation patients within the Military Health System.
- To identify demographic and socioeconomic factors associated with DOAC prescription rates.
Main Methods:
- A retrospective cross-sectional study utilizing administrative claims data from the MHS Data Repository for fiscal years 2018-2019.
- Inclusion criteria: TRICARE Prime and Prime Plus patients aged 18-64 with atrial fibrillation and a CHA 2 DS 2 -VASc score ≥ 2.
- Analysis included descriptive statistics and calculation of odds ratios for DOAC receipt based on gender, age, race, and socioeconomic status.
Main Results:
- A total of 5289 patients met the study criteria.
- Direct oral anticoagulants (DOACs) were prescribed to 40.71% of patients, while warfarin was prescribed to 4.92%.
- Significant disparities were observed: Black patients (aOR, 0.82) and females (aOR, 0.64) were less likely to receive DOACs compared to White patients and males, respectively. Senior officers were more likely to receive DOACs than senior enlisted personnel (aOR, 0.64).
Conclusions:
- Prescription patterns for direct oral anticoagulants (DOACs) in atrial fibrillation patients within the MHS exhibit significant variations based on race, gender, and socioeconomic status.
- These observed disparities in DOAC prescribing are not attributable to differences in insurance access or medication costs.
- Further research is warranted to address and mitigate these inequities in anticoagulant therapy within the Military Health System.
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