Trajectories of Oral Anticoagulation Adherence Among Medicare Beneficiaries Newly Diagnosed With Atrial Fibrillation
Trajectories of Oral Anticoagulation Adherence Among Medicare Beneficiaries Newly Diagnosed With Atrial Fibrillation
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DOI：
10.1161/jaha.118.011427
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发表时间：
2019-06-18
影响因子：
5.4
通讯作者：
Gellad, Walid F.
中科院分区：
文献类型：
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作者：
Hernandez, Inmaculada;He, Meiqi;Gellad, Walid F.
背景 - 在推荐口服抗凝药 (OAC) 的心房颤动 (AF) 患者中，只有 50% 使用这些药物，并且其中不到一半坚持使用 OAC。在新诊断为 AF 的 Medicare 受益人队列中，我们确定了具有相似 OAC 使用和依从性轨迹的患者群体，并评估了影响群体成员资格的患者特征。方法和结果 - 我们连续选择了 2014 年至 2015 年首次诊断 AF 的 Medicare D 部分受益人 (n=34 898)。我们计算了诊断后前 12 个月内使用 OAC 的天数比例，并使用基于组的轨迹模型确定了 OAC 依从轨迹。我们构建了多项逻辑回归模型来评估人口统计、系统级因素和临床特征与群体成员资格的关系。我们确定了 4 种 OAC 依从轨迹：从未使用过 OAC 的患者 (43.8%)、晚期 OAC 启动者 (7.6%)、早期 OAC 停用者 (8.9%) 和持续坚持的患者 (40.1%)。性别、黑人种族、居住在南方或 HAS-BLED 评分等预测因素不仅与 OAC 的使用相关，还与开始使用的时间和停止使用的可能性相关。例如，HAS-BLED 评分 >= 4 与不使用 OAC（比值比 1.35；95% CI，1.14-1.62）、较晚开始使用（1.55；95% CI，1.11-2.05）和早期停药（比值比 1.35；95% CI， 1.01-1.84).结论-我们在首次 AF 诊断后确定了 4 条不同的 OAC 依从轨迹，其中
Background-Only 50% of atrial fibrillation (AF) patients recommended for oral anticoagulation (OAC) use these medications, and less than half of them adhere to OAC. In a cohort of Medicare beneficiaries newly diagnosed with AF, we identified groups of patients with similar trajectories of OAC use and adherence, and evaluated patient characteristics affecting group membership.Methods and Results-We selected continuously enrolled Medicare Part D beneficiaries with first AF diagnosis in 2014 to 2015 (n=34 898). We calculated the proportion of days covered with OAC over the first 12 months after diagnosis and identified OAC adherence trajectories using group-based trajectory models. We constructed multinomial logistic regression models to evaluate how demographics, system-level factors, and clinical characteristics were associated with group membership. We identified 4 trajectories of OAC adherence: patients who never used OAC (43.8%), late OAC initiators (7.6%), early OAC discontinuers (8.9%), and continuously adherent patients (40.1%). Predictors such as sex, black race, residence in the South, or HAS-BLED score were associated with not only OAC use, but also the timing of initiation and the likelihood of discontinuation. For example, HAS-BLED score >= 4 was associated with a higher likelihood of not using OAC (odds ratio 1.35; 95% CI, 1.14-1.62), of late initiation (1.55; 95% CI, 1.11-2.05), and of early discontinuation (odds ratio 1.35; 95% CI, 1.01-1.84).Conclusions-We identified 4 distinct trajectories of OAC adherence after first AF diagnosis, with