Guideline-concordant initiation of oral anticoagulant therapy for stroke prevention in older veterans with atrial fibrillation eligible for Medicare Part D

Nicolae Done*, Amanda M. Roy, Yingzhe Yuan, Steven D. Pizer, Adam J. Rose, Julia C. Prentice

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: To characterize the rate of guideline-concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk. Data Sources/Study Setting: Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011-2015. Study Design: We identified 6619 elderly, high stroke-risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012-2015. We used logistic regression to estimate marginal effects of associations between patient characteristics and OAC initiation within 90 days of the first AF episode. Data Extraction Methods: We identified OACs using generic drug names. We calculated comorbidities and risk scores using diagnosis codes from 1 year of baseline data. Principal Findings: Overall, 66.5% of Medicare-eligible Veterans with AF at high risk of stroke initiated an OAC within 90 days. We found lower initiation rates for patients enrolled in Medicare Part D and those ineligible for drug co-payment subsidies. OAC initiation rates increased during the study among VHA-reliant patients but not among dual VHA-Part D enrollees. Conclusions: One-third of elderly Veterans at risk of stroke are not receiving recommended therapy. Increased coordination between Medicare and VHA providers may lead to improvements in anticoagulation quality and stroke prevention.

Original languageAmerican English
Pages (from-to)128-138
Number of pages11
JournalHealth Services Research
Volume54
Issue number1
DOIs
StatePublished - Feb 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Health Research and Educational Trust

Keywords

  • VA Health Care System
  • chronic disease
  • medical decision-making
  • pharmaceuticals: prescribing/use/costs

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