Abstract 15102: Treatment and Persistence With Oral Anticoagulants Among Newly Diagnosed Patients With Non-Valvular Atrial Fibrillation in a Commercially Insured and Medicare Advantage Population
Background: Treatment guidelines recommend oral anticoagulation (OAC) for non-valvular atrial fibrillation (NVAF) patients at high stroke risk (CHADS2 score ≥2). Real-world practice may differ from guidelines.
Objectives: To assess OAC treatment and persistence in newly diagnosed NVAF patients.
Methods: Medical and pharmacy claims between 11/1/10-11/30/13 were used from the HealthCore Integrated Research Database to identify and describe NVAF patients without atrial fibrillation (AF) diagnosis within 12 months prior to initial claim (newly diagnosed). Treated patients had ≥1 pharmacy fill for an OAC (warfarin, dabigatran, rivaroxaban or apixaban) during the above period. Proportion of treated NVAF patients was calculated and stratified by CHADS2 score. Demographic and clinical characteristics were described. Persistence was measured from initiation of OAC to discontinuation or end of eligibility or study period (11/30/2014).
Results: Among 45,092 newly diagnosed NVAF patients, 41.1% were treated with an OAC. The proportion treated differed only slightly by baseline stroke risk (CHADS2 <2: 39.8%; CHADS2=2 or 3: 42.4%, and CHADS2>3: 40.3%: p<0.001). Compared with untreated, treated patients were younger (age: 70±12.2 vs 71±14.3 years; p<.001), more likely male (males: 59.7% vs 52.5%; p<.001), had a higher stroke risk (CHADS2: 2.03±1.3 vs 1.98±1.4; p<.001) and lower bleed risk (HEMORR2HAGES: 2.55±1.8 vs 2.80±1.9; p<.001). For both treated and untreated patients, those in higher CHADS2 score categories also had higher HEMORR2HAGES scores. Patients were followed for an average of 2.25 years (821±309 (median =770) days). In the follow-up, 72.7% patients discontinued OAC treatment; nearly one-fourth of patients discontinued within 3 months and 55% within 12 months. Mean time to discontinuation was 255±249 days.
Discussion: Challenges appear to exist for initiation and persistence with OAC therapy among newly diagnosed NVAF patients in real-world practice. The proportion of NVAF patients who received treatment was lower than previously reported and differed only slightly by stroke risk. Patients with higher stroke risk also had higher bleed risk, suggesting clinicians may incorporate both in the decision to treat NVAF patients with OACs.
Author Disclosures: R. Jain: Employment; Modest; HealthCore, which is a consultancy whose activities on the project were funded by Boehringer Ingelheim. J. Franchino-Elder: Employment; Significant; Boehringer Ingelheim. A. Fu: Employment; Modest; was employed by HealthCore at the time of the study. HealthCore is a research consultancy whose activities on the project were funded by Boehringer Ingelheim. C. Wang: Employment; Significant; Boehringer Ingelheim Inc. S. Sander: Employment; Significant; Boehringer Ingelheim Inc. H. Tan: Employment; Modest; HealthCore, which is a consultancy whose activities on the project were funded by Boehringer Ingelheim. E. Kraft: Employment; Modest; Anthem Inc a health insurance company. V. Willey: Employment; Modest; HealthCore, which is a consultancy whose activities on the project were funded by Boehringer Ingelheim.
- © 2016 by American Heart Association, Inc.