Clinical research studyPatterns of Initiation of Oral Anticoagulants in Patients with Atrial Fibrillation— Quality and Cost Implications
Section snippets
Study Population and Data Source
We used nationwide medical and prescription claims data from commercial patients covered by Aetna, a large health care benefits company, to create a cohort of patients with newly diagnosed nonvalvular atrial fibrillation who were prescribed an oral anticoagulant between October 1, 2010 and June 30, 2013.
These data contained complete paid claims data for all procedures, physician encounters, hospitalizations, and filled prescriptions (including dose dispensed and amounts paid by the insurer and
Results
The study cohort consisted of 6893 patients with nonvalvular atrial fibrillation newly initiated on an oral anticoagulant between October 1, 2010 and June 30, 2013 (Appendix, available online). Patients had a mean age of 61.3 years, were predominantly male (72.8%), and had mean CHADS2 and HAS-BLED scores of 1.7 and 2.0, respectively (Table 1). Approximately one third of patients had a history of coronary artery disease, and one quarter had diabetes. Heart failure, renal dysfunction, or history
Discussion
This study of a contemporary cohort of patients with atrial fibrillation starting oral anticoagulant therapy demonstrates rapid adoption of novel anticoagulants into clinical practice, utilization associated with lower CHADS2 and HAS-BLED scores, and significant health care cost implications. This study is the first, to our knowledge, to evaluate real-world use of all novel anticoagulants currently on the market.6
We observed a significant decline in the proportion of patients with atrial
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2021, American Heart JournalCitation Excerpt :We included patients if they had at least one inpatient or outpatient diagnosis of atrial fibrillation in the 6 months prior to cohort entry and excluded patients with any alternate indication for anticoagulation, including deep vein thrombosis, pulmonary embolism, prosthetic heart valve, mitral valve stenosis, and hip or knee replacement surgery. All clinical exclusion and inclusion criteria were defined using a combination of International Classification of Diseases (ICD) codes, current procedural terminology codes, and Word Health Organization Anatomical Therapeutic Chemical classification system codes (Supplementary Table 1).1,11,28-31 Though the claims database included Medicare Advantage patients, we limited our cohort to commercially insured patients, since patients in Medicare prescription drug plans include a phased benefit design such that out-of-pocket costs for the first prescription depend on cumulative annual prescription drug spending and may not reflect ongoing out-of-pocket costs.
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Funding: This work was funded by an unrestricted research grant from CVS Caremark to Brigham and Women's Hospital.
Conflicts of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.