Adherence to Anticoagulation and Risk of Stroke Among Medicare Beneficiaries Newly Diagnosed with Atrial Fibrillation

The objective of this study was to compare the risk of stroke in atrial fibrillation (AF) with adherent use of oral anticoagulation (OAC), non-adherent use, and non-use of OAC.MethodsUsing 2013 –2016 Medicare claims data, we identified patients newly diagnosed with AF in 2014–2015 and collected prescriptions filled for OAC in the 12 months after AF diagnosis (n = 39,272). We categorized participants each day into three time-dependent exposures: adherent use (≥ 80% of the previous 30 days covered with OAC), non-adherent use (0–80% covered with OAC), and non-use (0%). We constructed Cox proportional hazards models to estimate the association betw een time-dependent exposures and time to stroke, adjusting for demographics and clinical characteristics.ResultsThe sample included 39,272 patients. Study participants spent 35.0% of the follow-up period in the adherent use exposure category, 10.9% in the non-adherent category, and 54.0% in the non-use category. OAC adherent use [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.52 –0.74] and non-adherent use (HR 0.74; 95% CI 0.57–0.95) were associated with lower hazards of stroke than non-use. Adherent use of DOAC (HR 0.54; 95% CI 0.42–0.69) and warfarin (HR 0.70; 95% CI 0.56–0.89) was associated with lower risk of stroke than non-use, but the risk of stroke did not s tatistically differ between DOAC and warfarin adherent use (HR 0.77; 95% CI 0.56–1.04).DiscussionAlthough adherence to OAC reduces stroke ...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research