Abstract 15577: Anticoagulant Use and Bleeding Risk in Patients With Atrial Fibrillation: Findings From a Multi-Payer Analysis
Objective: Oral anticoagulation is effective at reducing risk of stroke in patients with atrial fibrillation (AF); however, thromboprophylaxis also increases the risk of a major bleeding event. Given that new assessments for estimating bleed risk in AF have been studied in recent trial populations (e.g., HAS-BLED, ATRIA), it is important to evaluate bleed risk and its impact on treatment patterns among a “real-world” population. This study analyzed recent administrative claims data from Medicaid, Medicare and commercial insurance to estimate stroke and bleed risk and use of anticoagulants in patients with AF.
Methods: Retrospective data analyses were performed using a software tool designed to analyze health plan data. Five data sources were analyzed: 1) IMS LifeLink Database (IMS); 2) OptumInsight (Optum); 3) MarketScan Commercial (MSComm); 4) MarketScan Medicare Supplemental (MSMedicare); and 5) a Medicaid database from a southern US state (Medicaid). Included patients were aged ≥ 18 years with a new or existing diagnosis of AF. The first observed AF diagnosis constituted the index date, with patient outcomes assessed over one year. Study measures included stroke risk (identified by CHADS2 score), bleeding risk (identified by ATRIA score), and anticoagulant use.
Results: A total of 102,577 patients with AF (mean age: 56 - 79 years) met inclusion criteria. High bleeding risk (ATRIA ≥5 points) was estimated in 19% (IMS), 13% (Optum), 4% (MSComm), 25% (MSMedicare), and 21% (Medicaid) of study patients. Among patients with high stroke risk (CHADS2 ≥2 points) and low bleeding risk (ATRIA 0-3 points), 45-82% did not receive an anticoagulant, with the highest proportion observed in Medicare (58%) and Medicaid (82%) populations. Conversely, 20-54% of patients with high stroke risk and high bleeding risk received an anticoagulant. Major bleed events were rare (i.e. 1%) during follow-up.
Conclusions: Inadequate levels of thromboprophylaxis coverage among AF patients with high stroke risk and low bleeding risk raise important concerns for both private and public health plan populations. Further investigation on the impact of this treatment pattern on patient outcomes is warranted.
- © 2013 by American Heart Association, Inc.