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 language | American English |
|---|---|
| Pages (from-to) | 128-138 |
| Number of pages | 11 |
| Journal | Health Services Research |
| Volume | 54 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:funded by grant number IIR 15-139 from the Health Services Research and Development Service of the Department of Veterans Affairs. All opinions expressed are those of the authors and do not necessarily reflect the official position of the U.S. Department of Veterans Affairs, Boston University, or Northeastern University. The authors wish to thank Aaron Legler and Julia Martin for providing outstanding statistics programming support. None of the authors have any conflict of interests to disclose. Previous versions of this work were presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Meeting 2017 and at the AcademyHealth Annual Research Meeting 2017.
Funding Information:
Joint Acknowledgment/Disclosure Statement: This research was funded by grant number IIR 15-139 from the Health Services Research and Development Service of the Department of Veterans Affairs. All opinions expressed are those of the authors and do not necessarily reflect the official position of the U.S. Department of Veterans Affairs, Boston University, or Northeastern University. The authors wish to thank Aaron Legler and Julia Martin for providing outstanding statistics programming support. None of the authors have any conflict of interests to disclose. Previous versions of this work were presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Meeting 2017 and at the AcademyHealth Annual Research Meeting 2017.
Publisher Copyright:
© Health Research and Educational Trust
Keywords
- VA Health Care System
- chronic disease
- medical decision-making
- pharmaceuticals: prescribing/use/costs
