Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 8, Issue 17, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.119.012646
Keywords
anticoagulation; atrial fibrillation; practice variation; stroke prevention; veterans
Categories
Funding
- National Heart, Lung, and Blood Institute of the NIH [R01HL125089]
- National Heart, Lung, and Blood Institute [R01HL137734, R01HL126911, R01HL137794, R01HL13660, R01HL141434]
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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.
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