Pandemic Disruptions of Atrial Fibrillation Care

项目摘要 心房颤动（AF）是一种心律失常，在美国影响超过500万人， 中风的风险。AF是衡量COVID-19大流行对非COVID-19影响的一种危重疾病状态。 疾病，因为AF卒中预防的各个方面都容易受到破坏：1）新发患者 AF可能更容易未被诊断。2)已确诊的房颤患者可能存在并发症， 未被发现，并且在没有治疗的情况下恶化。3)新诊断为AF的患者可能不太可能开始 口服抗凝剂（OAC）预防卒中治疗。4)OAC用户可能会增加 难以坚持治疗。5)服用华法林（一种需要进行常规血液检查的OAC药物）的患者， 监测频率较低。 我们的目标是衡量COVID-19大流行对诊断、治疗启动、治疗 坚持，监测和AF患者的健康结果。我们将确定是否流行 AF护理的中断加剧了健康差距。我们还将评估远程医疗的作用， 这一流行病推动了这一做法的推广，抵消了危机期间获得现场护理机会减少的影响。 我们将使用2015-2022年Medicare按服务收费受益人和Optum® Integrated索赔的索赔数据- 商业保险和Medicare Advantage受益人的电子健康记录数据。了建设一 中断的时间序列分析，以衡量大流行开始和结束后的结果变化。到 为了确定这一流行病是否加剧了差距，我们将测试 结果因年龄、性别、种族/民族以及城市化、社会经济地位 剥夺、种族构成和隔离。在目标3和4中，我们将使用边际结构模型来 估计远程保健访问与结果之间的关联。我们将实现四个具体目标： (1)量化2016-2021年新发AF诊断发生率的变化，包括新发AF诊断 表现为中风;（2）确定COVID-19大流行是否与OAC降低相关 在新诊断的AF患者中开始;（3）量化OAC依从性和监测的变化 在已确诊的房颤患者中进行治疗;（4）量化卒中，出血， 心血管住院和死亡。 我们量化大流行对房颤治疗的影响将对提供慢性房颤治疗产生重大影响。 紧急情况下的疾病护理。我们确定了受这一流行病严重影响的人口 我们对远程医疗抵消现场护理减少的能力的确定将为我们提供信息， 防止紧急情况下避免护理的临床指南和政策，优化了 在重大危机期间提供慢性病护理，并保护弱势群体。

Project Summary Atrial fibrillation (AF) is a cardiac arrythmia that affects over 5 million individuals in the US and quintuples the risk of stroke. AF is a critical disease state to measure the effects of the COVID-19 pandemic on non-COVID disease because every aspect of stroke prevention in AF is vulnerable to disruption: 1) Patients with new onset AF may be more likely to remain undiagnosed. 2) Established AF patients may have complications that remain undetected and worsen without treatment. 3) Patients newly diagnosed with AF may be less likely to initiate stroke prevention therapy with oral anticoagulation (OAC). 4) Established OAC users may have increased difficulty adhering to therapy. 5) Patients on warfarin, an OAC agent that requires routine blood tests, may have less frequent monitoring. Our goal is to measure the impact of the COVID-19 pandemic on diagnosis, therapy initiation, therapy adherence, monitoring, and health outcomes for patients with AF. We will determine whether pandemic disruptions of AF care have exacerbated health disparities. We will also assess the role of telemedicine, whose uptake has been catalyzed by the pandemic, in offsetting decreased access to in-person care during crises. We will use 2015-2022 claims data for Medicare fee-for-service beneficiaries and Optum® Integrated claims- electronic health record data for commercially insured and Medicare Advantage beneficiaries. We will construct interrupted time series analyses to measure changes in outcomes after pandemic start and pandemic end. To determine whether the pandemic has exacerbated disparities, we will test whether the degree of change in outcomes differed by age, sex, race/ethnicity, and area-level measures of urbanization, socioeconomic status, deprivation, racial composition, and segregation. In aims 3 and 4, we will use marginal structural models to estimate the association between telehealth visits and outcomes. We will achieve four specific aims: (1) quantify changes in the incidence rate of new AF diagnoses in 2016-2021, including new AF diagnoses manifesting as stroke; (2) determine whether the COVID-19 pandemic was associated with decreased OAC initiation among newly diagnosed AF patients; (3) quantify changes in adherence and monitoring of OAC therapy among established AF patients; (4) quantify changes in the incidence rates of stroke, bleeding, cardiovascular hospitalization, and death among established AF patients. Our quantification of pandemic effects on AF care will have major implications for the provision of chronic disease care during emergencies. Our identification of populations disproportionately affected by the pandemic and our determination of the ability of telemedicine to offset decreased access to in-person care will inform clinical guidance and policies that prevent care avoidance during health emergencies, optimize models for the delivery of chronic disease care during major crises, and protect vulnerable populations.