Anticoagulant prescribing for non-valvular atrial fibrillation in the Veterans Health Administration

Anticoagulant prescribing for non-valvular atrial fibrillation in the Veterans Health Administration. Rose, A., Goldberg, R, McManus, D., Kapoor, A, Wang, V, Liu, W, & Yu, H Journal of the American Heart Association, 2019.
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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-of-pocket 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.

@article{rose_anticoagulant_2019,
	title = {Anticoagulant prescribing for non-valvular atrial fibrillation in the {Veterans} {Health} {Administration}},
	doi = {10.1161/JAHA.119.012646},
	abstract = {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-of-pocket 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.},
	journal = {Journal of the American Heart Association},
	author = {Rose, AJ and Goldberg, R and McManus, DD and Kapoor, A and Wang, V and Liu, W and Yu, H},
	year = {2019},
	pmid = {31441364 PMCID:PMC6755851},
}

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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.","journal":"Journal of the American Heart Association","author":[{"propositions":[],"lastnames":["Rose"],"firstnames":["AJ"],"suffixes":[]},{"propositions":[],"lastnames":["Goldberg"],"firstnames":["R"],"suffixes":[]},{"propositions":[],"lastnames":["McManus"],"firstnames":["DD"],"suffixes":[]},{"propositions":[],"lastnames":["Kapoor"],"firstnames":["A"],"suffixes":[]},{"propositions":[],"lastnames":["Wang"],"firstnames":["V"],"suffixes":[]},{"propositions":[],"lastnames":["Liu"],"firstnames":["W"],"suffixes":[]},{"propositions":[],"lastnames":["Yu"],"firstnames":["H"],"suffixes":[]}],"year":"2019","pmid":"31441364 PMCID:PMC6755851","bibtex":"@article{rose_anticoagulant_2019,\n\ttitle = {Anticoagulant prescribing for non-valvular atrial fibrillation in the {Veterans} {Health} {Administration}},\n\tdoi = {10.1161/JAHA.119.012646},\n\tabstract = {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-of-pocket 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. 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