Characteristics affecting oral anticoagulant therapy choice among patients with non-valvular atrial fibrillation: a retrospective claims analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Anticoagulants/*administration & dosage ; Atrial Fibrillation/*drug therapy ; Benzimidazoles/*administration & dosage ; Practice Patterns, Physicians'/*statistics & numerical data ; Stroke/*prevention & control ; beta-Alanine/*analogs & derivatives; Administration, Oral ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Dabigatran ; Female ; Humans ; Insurance Claim Review ; Male ; Middle Aged ; Retrospective Studies ; Risk ; United States ; Warfarin/administration & dosage ; beta-Alanine/administration & dosage

Background: Dabigatran is one of the three newer oral anticoagulants (OACs) recently approved in the United States for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. The objective of this study was to identify patient, healthcare provider, and health plan factors associated with dabigatran versus warfarin use among NVAF patients.
Methods: Administrative claims data from patients with ≥ 2 NVAF medical claims in the HealthCore Integrated Research Database between 10/1/2009 and 10/31/2011 were analyzed. During the study intake period (10/1/2010 - 10/31/2011), dabigatran patients had ≥ 2 dabigatran prescriptions, warfarin patients had ≥ 2 warfarin and no dabigatran prescriptions, and the first oral anticoagulant (OAC) prescription date was the index date. Continuous enrollment for 12 months preceding ("pre-index") and ≥ 6 months following the index date was required. Patients without pre-index warfarin use were assigned to the 'OAC-naïve' subgroup. Separate analyses were performed for 'all-patient' and 'OAC-naïve' cohorts. Multivariable logistic regression (LR) identified factors associated with dabigatran versus warfarin use.
Results: Of 20,320 patients (3,019 dabigatran and 17,301 warfarin) who met study criteria, 27% of dabigatran and 13% of warfarin patients were OAC-naïve. Among all-patients, dabigatran patients were younger (mean 67 versus 73 years, p < 0.001), predominantly male (71% versus 61%, p < 0.001), and more frequently had a cardiologist prescriber (51% versus 30%, p < 0.001) than warfarin patients. Warfarin patients had higher pre-index Elixhauser Comorbidity Index (mean: 4.3 versus 4.0, p < 0.001) and higher ATRIA bleeding risk score (mean: 3.0 versus 2.3, p < 0.001). LR results were generally consistent between all- and OAC-naïve patients. Among OAC-naïve patients, strongest factors associated with dabigatran use were prescriber specialty (OR = 3.59, 95% CI 2.68-4.81 for cardiologist; OR = 2.22, 95% CI 1.65-2.97 for other specialist), health plan type (OR = 1.47 95% CI 1.10-1.96 for preferred provider organization), and prior ischemic stroke (OR = 1.42, 95% CI 1.06-1.90). Older age decreased the probability of dabigatran use.
Conclusions: Beside patient characteristics, cardiology specialty of the prescribing physician and health plan type were the strongest factors associated with dabigatran use.

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0 (Anticoagulants)
0 (Benzimidazoles)
11P2JDE17B (beta-Alanine)
5Q7ZVV76EI (Warfarin)
I0VM4M70GC (Dabigatran)

Date Created: 20140719 Date Completed: 20150114 Latest Revision: 20220321

20240829

PMC4112613

10.1186/1472-6963-14-310

25034699