Anticoagulant prescribing for non-valvular atrial fibrillation in the veterans health administration

Adam J. Rose*, Robert Goldberg, David D. McManus, Alok Kapoor, Victoria Wang, Weisong Liu, Hong Yu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Background-Direct acting oral anticoagulants (DOACs) theoretically could contribute to addressing underuse of anticoagulation in non-valvular atrial fibrillation (NVAF). Few studies have examined this prospect, however. The potential of DOACs to address underuse of anticoagulation in NVAF could be magnified within a healthcare system that sharply limits patients’ exposure to out-ofpocket copayments, such as the Veterans Health Administration (VA). Methods and Results-We used a clinical data set of all patients with NVAF treated within VA from 2007 to 2016 (n=987 373). We examined how the proportion of patients receiving any anticoagulation, and which agent was prescribed, changed over time. When first approved for VA use in 2011, DOACs constituted a tiny proportion of all prescriptions for anticoagulants (2%); by 2016, this proportion had increased to 45% of all prescriptions and 67% of new prescriptions. Patient characteristics associated with receiving a DOAC, rather than warfarin, included white race, better kidney function, fewer comorbid conditions overall, and no history of stroke or bleeding. In 2007, before the introduction of DOACs, 56% of VA patients with NVAF were receiving anticoagulation; this dipped to 44% in 2012 just after the introduction of DOACs and had risen back to 51% by 2016. Conclusions-These results do not suggest that the availability of DOACs has led to an increased proportion of patients with NVAF receiving anticoagulation, even in the context of a healthcare system that sharply limits patients’ exposure to out-of-pocket copayments.

Original languageAmerican English
Article numbere012646
JournalJournal of the American Heart Association
Volume8
Issue number17
DOIs
StatePublished - 3 Sep 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 The Authors and RAND Corporation.

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Practice variation
  • Stroke prevention
  • Veterans

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