Home › Research › Health systems and care delivery
Factors associated with delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation
Xiaochan Luo, Jakson Roberto Gaeski de Chaves, Andrew Wang, David R. Steffen, A D Dhamane, Feng Dai. European Heart Journal, 2023-11-01
Topic: Risk, prevention and care in population studies
Abstract Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the United States (US) and is associated with increased risk of stroke.1 Oral anticoagulants (OACs) are the primary treatment to reduce stroke risk in patients with AF.2,3 However, there is recent evidence of underuse of OAC in AF patients.4 Purpose To identify factors associated with delayed OAC treatment initiation among AF patients in the US clinical practice. Factors associated with delayed OAC initiation were assessed using multivariable logistic regressions. Results A total of 446,441 patients met the inclusion criteria. Factors associated with delayed OAC initiation included Black race (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.25–1.33), South and West US census regions (OR: 1.22, 95%CI: 1.19–1.24 and OR: 1.29, 95%CI: 1.26–1.32, respectively), dementia (OR: 1.27, 95%CI: 1.23–1.30), congestive heart failure (OR: 1.20, 95%CI: 1.26–1.32), bleeding hospitalization ≤3 months before 1st AF diagnosis (OR: 1.22, 95%CI: 1.18–1.27), prior authorization (OR: 1.69, 95%CI: 1.66–1.71), and tier 4 formulary for index OAC at AF diagnosis (OR: 1.26, 95%CI: 1.22–1.30). Additionally, having low-income subsidy or dual eligibility (for Medicare and Medicaid) was associated with increased odds of delayed OAC initiation (OR: 1.06, 95%CI: 1.02–1.10 and OR: 1.09, 95%CI: 1.05–1.14, respectively; Figure 1). Conclusions In this study on Medicare patients with AF, Black race, low-income subsidy, and dual eligibility were found to be associated with delayed OAC initiation, suggesting potential disparities in the care of AF with timely OAC treatment. Moreover, OAC requiring prior authorization (the strongest predictor) or being on formulary tier 4 were associated with delayed initiation, indicating formulary restrictions may create barriers to timely OAC access for AF patients.Table 1.Patient characteristicsFigure 1.Factors of delayed initiation
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Luo, X., de Chaves, J. R. G., Wang, A., Steffen, D. R., Dhamane, A. D., & Dai, F. (2023). Factors associated with delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation. European Heart Journal. https://doi.org/10.1093/eurheartj/ehad655.535
Vancouver
Luo X, de Chaves JRG, Wang A, Steffen DR, Dhamane AD, Dai F. Factors associated with delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation. European Heart Journal. 2023. doi:10.1093/eurheartj/ehad655.535.
BibTeX
@article{luo2023-9f1100a2,
author = {Luo, Xiaochan and de Chaves, Jakson Roberto Gaeski and Wang, Andrew and Steffen, David R. and Dhamane, A D and Dai, Feng},
title = {{Factors associated with delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation}},
journal = {European Heart Journal},
year = {2023},
doi = {10.1093/eurheartj/ehad655.535},
url = {https://doi.org/10.1093/eurheartj/ehad655.535}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Abstract Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the United States (US) and is associated with increased risk of stroke.1 Oral anticoagulants (OACs) are the primary treatment to reduce stroke risk in patients with AF.2,3 However, there is recent evidence of underuse of OAC in AF patients.4 Purpose To identify factors associated with delayed OAC treatment initiation among AF patients in the US clinical practice.
- Factors associated with delayed OAC initiation were assessed using multivariable logistic regressions.
- Results A total of 446,441 patients met the inclusion criteria.
- Factors associated with delayed OAC initiation included Black race (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.25–1.33), South and West US census regions (OR: 1.22, 95%CI: 1.19–1.24 and OR: 1.29, 95%CI: 1.26–1.32, respectively), dementia (OR: 1.27, 95%CI: 1.23–1.30), congestive heart failure (OR: 1.20, 95%CI: 1.26–1.32), bleeding hospitalization ≤3 months before 1st AF diagnosis (OR: 1.22, 95%CI: 1.18–1.27), prior authorization (OR: 1.69, 95%CI: 1.66–1.71), and tier 4 formulary for index OAC at AF diagnosis (OR: 1.26, 95%CI: 1.22–1.30).
- Additionally, having low-income subsidy or dual eligibility (for Medicare and Medicaid) was associated with increased odds of delayed OAC initiation (OR: 1.06, 95%CI: 1.02–1.10 and OR: 1.09, 95%CI: 1.05–1.14, respectively; Figure 1).
Why it matters
This study found that among Medicare patients with atrial fibrillation, having dementia was among the factors linked to delayed start of oral anticoagulants. It is about stroke-prevention medication timing, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Participants446,441
- Effect sizeor 7.1; or 6.8; or 15.7
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (European Heart Journal) |
| Journal's citation record | 3 / 4 | European Heart Journal: journal h-index 456 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 446,441 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Feng Dai: h-index 35 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Pfizer (United States): institution h-index 832 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 2 countries |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 41 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Related
Studies in the library that share something with this one. The line above each title says what.
Related studies in Health systems and care delivery
Also tagged “placebo-controlled”
783 studies in the library carry the topic tag “placebo-controlled”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 783 tagged studies.