The following is a summary of “Delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation,” published in the March 2024 issue of Cardiology by Luo et al.
Delaying oral anticoagulant (OAC) treatment in atrial fibrillation (AF) conditions can lead to an increased risk of stroke, systemic embolism, or recurrent thromboembolic events.
Researchers conducted a retrospective study to identify factors linked with delayed OAC treatment among patients with AF.
They used a data frame containing information on Medicare beneficiaries with newly diagnosed AF at≥65 and prescribed OAC treatment between 1 October 2015 and 2019. OAC initiation was delayed if it took more than 3 months from AF diagnosis. A multivariable logistic regression model was optimized to analyze the association between delayed initiation of OAC treatment and other demographic and clinical factors, including OAC coverage and formulary characteristics.
The result evaluated 446,441 eligible patients, with 30.0% (N=131,969) seeing delay and 70.0% (N = 314,472) witnessing early OAC initiation. Both groups had a median age of 78 years. In early and delayed OAC cohorts, 47.1% and 47.6% were male, and 88.8% and 86.6% were White, respectively. Factors linked with delayed initiation included Black race (OR 1.29; 95% CI 1.25-1.33), west region (OR 1.29; 95% CI 1.26-1.32), dementia (OR 1.27; 95% CI 1.23-1.30), recent bleeding hospitalization (OR 1.22; 95% CI 1.18-1.27), prior authorization (OR 1.69; 95% CI 1.66-1.71), and tier 4 formulary for index OAC (OR 1.26; 95% CI 1.22-1.30).
Investigators found that almost one-third of Medicare patients with AF experienced delayed OAC initiation. Crucial factors related to this included race and ethnicity, comorbidities, and formulary restrictions.
Source: sciencedirect.com/science/article/pii/S2666602224000120