Oral anticoagulant underutilization among elderly patients with atrial fibrillation: insights from the United States Medicare database.
Oral anticoagulant underutilization among elderly patients with atrial fibrillation: insights from the United States Medicare database.
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DOI：
10.1007/s10840-022-01274-1
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发表时间：
2023-04
影响因子：
1.8
通讯作者：
Hsu, Jonathan C.
中科院分区：
文献类型：
--
作者：
Munir, Muhammad Bilal;Hlavacek, Patrick;Keshishian, Allison;Guo, Jennifer D.;Mallampati, Rajesh;Ferri, Mauricio;Russ, Cristina;Emir, Birol;Cato, Matthew;Yuce, Huseyin;Hsu, Jonathan C.
口服抗凝剂（OAC）可降低房颤（AF）患者的卒中风险。本研究的目的是分析OAC使用不足的患病率和预测因素。从US CMS数据库（2013年1月1日至2017年12月31日）中识别出CHA 2DS 2-VASc评分≥ 2的新诊断AF患者。患者根据是否使用OAC处方进行分层，OAC处方组根据直接OAC（DOAC）与华法林进行分层。多变量逻辑回归模型被用来研究OAC利用不足的预测因素。在1，204，507例确定的AF患者中，617，611例患者（51.3%）在随访期间未处方OAC（平均：2.4年），586，896例患者（48.7%）在此期间处方OAC（DOAC：388，629 [66.2%];华法林：198，267 [33.8%]）。年龄≥ 85岁（比值比[OR] 0.55，95%置信区间[CI] 0.55-0.56），女性（OR 0.96，95% CI 0.95-0.96），黑人（OR 0.78，95% CI 0.77-0.79）和合并症，如胃肠道（GI; OR 0.43，95% CI 0.41-0.44）和颅内出血（OR 0.29，95% CI 0.28-0.31）与OAC利用率较低相关。年龄≥ 85岁（OR 0.92，95% CI 0.91-0.94），黑人（OR 0.78，95%CI 0.76-0.80），缺血性中风（OR 0.77，95% CI 0.75-0.80）、GI出血（OR 0.73，95% CI 0.68-0.77）和颅内出血（OR 0.72，95% CI 0.65-0.80）预测DOAC的使用率低于华法林。尽管OAC治疗处方是AF患者预防卒中的标准治疗，但其在≥ 65岁的Medicare患者中的总体利用率仍然较低，特定的患者特征预测了利用率不足。在线版本包含补充材料，可通过10.1007/s10840-022-01274-1获得。
Oral anticoagulants (OACs) mitigate stroke risk in patients with atrial fibrillation (AF). The study aim was to analyze prevalence and predictors of OAC underutilization. Newly diagnosed AF patients with a CHA2DS2-VASc score ≥ 2 were identified from the US CMS Database (January 1, 2013–December 31, 2017). Patients were stratified based on having an OAC prescription versus not and the OAC prescription group was stratified by direct OAC (DOACs) versus warfarin. Multivariable logistic regression models were used to examine predictors of OAC underutilization. Among 1,204,507 identified AF patients, 617,611 patients (51.3%) were not prescribed an OAC during follow-up (mean: 2.4 years), and 586,896 patients (48.7%) were prescribed an OAC during this period (DOAC: 388,629 [66.2%]; warfarin: 198,267 [33.8%]). Age ≥ 85 years (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.55–0.56), female sex (OR 0.96, 95% CI 0.95–0.96), Black race (OR 0.78, 95% CI 0.77–0.79) and comorbidities such as gastrointestinal (GI; OR 0.43, 95% CI 0.41–0.44) and intracranial bleeding (OR 0.29, 95% CI 0.28–0.31) were associated with lower utilization of OACs. Furthermore, age ≥ 85 years (OR 0.92, 95% CI 0.91–0.94), Black race (OR 0.78, 95% CI 0.76–0.80), ischemic stroke (OR 0.77, 95% CI 0.75–0.80), GI bleeding (OR 0.73, 95% CI 0.68–0.77), and intracranial bleeding (OR 0.72, 95% CI 0.65–0.80) predicted lower use of DOACs versus warfarin. Although OAC therapy prescription is the standard of care for stroke prevention in AF patients, its overall utilization is still low among Medicare patients ≥ 65 years old, with specific patient characteristics that predict underutilization. The online version contains supplementary material available at 10.1007/s10840-022-01274-1.
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影响因子：
5.4
作者：
Thompson LE;Maddox TM;Lei L;Grunwald GK;Bradley SM;Peterson PN;Masoudi FA;Turchin A;Song Y;Doros G;Davis MB;Daugherty SL
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通讯作者：
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