Underutilization of Oral Anticoagulant Therapy Among Elderly Patients With Atrial Fibrillation: Insights From the United States Medicare Database

Delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation

“…Our observations from a large dataset extend previously published results showing racial/ethnicity disparities in OAC utilization following AF diagnosis which persist in more recent years. For example, two studies using older CMS Medicare data (2012–2017 and 2014–2015) found that compared with White race, Black race was associated with lower utilization of OACs within 6 months after patient's first AF diagnosis [ 17 ] or was associated with not being prescribed OACs, delayed initiation, and early discontinuation [ 23 ], respectively. A longitudinal study of patients newly diagnosed with AF in 2011–2017 from the Northwestern Medicine Enterprise Data Warehouse reported significantly lower odds of receiving any OAC within 1 year of AF diagnosis in Black and Asian patients compared with White patients [ 15 ].…”

“…A 2020 US commercial claims analysis reported underuse of OACs in patients with AF despite no clear contraindications — 36 % of eligible AF patients receiving early education intervention on the use of OACs had no evidence of OAC use in the prior 12 months [ 16 ]. An analysis using the Centers for Medicare & Medicaid Services (CMS) fee-for-service Medicare dataset (100 %) from 2012 to 2017 found that 51.3 % of patients with AF did not receive any OAC during a 6-month follow-up period after their first AF diagnosis [ 17 ]. Moreover, government and commercial payers have increasingly implemented more stringent formulary restrictions to contain costs, introducing additional hurdles to patient access to treatment.…”