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Adherence to Anticoagulation and Risk of Stroke Among Medicare Beneficiaries Newly Diagnosed with Atrial Fibrillation

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Abstract

Introduction

The objective of this study was to compare the risk of stroke in atrial fibrillation (AF) with adherent use of oral anticoagulation (OAC), non-adherent use, and non-use of OAC.

Methods

Using 2013–2016 Medicare claims data, we identified patients newly diagnosed with AF in 2014–2015 and collected prescriptions filled for OAC in the 12 months after AF diagnosis (n = 39,272). We categorized participants each day into three time-dependent exposures: adherent use (≥ 80% of the previous 30 days covered with OAC), non-adherent use (0–80% covered with OAC), and non-use (0%). We constructed Cox proportional hazards models to estimate the association between time-dependent exposures and time to stroke, adjusting for demographics and clinical characteristics.

Results

The sample included 39,272 patients. Study participants spent 35.0% of the follow-up period in the adherent use exposure category, 10.9% in the non-adherent category, and 54.0% in the non-use category. OAC adherent use [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.52–0.74] and non-adherent use (HR 0.74; 95% CI 0.57–0.95) were associated with lower hazards of stroke than non-use. Adherent use of DOAC (HR 0.54; 95% CI 0.42–0.69) and warfarin (HR 0.70; 95% CI 0.56–0.89) was associated with lower risk of stroke than non-use, but the risk of stroke did not statistically differ between DOAC and warfarin adherent use (HR 0.77; 95% CI 0.56–1.04).

Discussion

Although adherence to OAC reduces stroke risk by nearly 40%, newly diagnosed AF patients in Medicare adhere to OAC on average only one third of the first year after AF diagnosis.

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Acknowledgments

This work represents the opinions of the authors alone and does not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 3609 Forbes Avenue, Room 103, Pittsburgh, PA, 15261, USA

    Inmaculada Hernandez & Meiqi He

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Maria M. Brooks

  3. Heart and Vascular Institute, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA

    Samir Saba

  4. Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Walid F. Gellad

  5. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Walid F. Gellad

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  1. Inmaculada Hernandez
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  2. Meiqi He
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Corresponding author

Correspondence to Inmaculada Hernandez.

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Funding

This work was funded by the National Heart, Lung and Blood Institute (Grant number K01HL142847).

Conflict of interest

Saba has received research support from Boston Scientific. Hernandez has received advisory board fees from Pfizer. He, Brooks and Gellad declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Hernandez, I., He, M., Brooks, M.M. et al. Adherence to Anticoagulation and Risk of Stroke Among Medicare Beneficiaries Newly Diagnosed with Atrial Fibrillation. Am J Cardiovasc Drugs 20, 199–207 (2020). https://doi.org/10.1007/s40256-019-00371-3

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