Key result
Prior authorization requirements linked to ~69% higher odds of delayed oral anticoagulant initiation.
Why the study?
This study aimed to identify factors associated with delayed oral anticoagulant treatment initiation among patients with atrial fibrillation in US clinical practice.
Cohort (n=446,441)
Yes
Nearly one-third of Medicare beneficiaries newly diagnosed with atrial fibrillation experience delayed initiation of oral anticoagulants, significantly influenced by Black race, specific comorbidities, and restrictive payer policies such as prior authorizations and high formulary tiers.
Prior authorization may delay OAC initiation after new AF diagnosis; leaves open whether easing these requirements improves timely stroke prevention.
Study objective: This study aimed to identify factors associated with delayed oral anticoagulant (OAC) treatment initiation among atrial fibrillation (AF) patients in United States (US) clinical practice. Participants: Medicare beneficiaries newly diagnosed with AF without moderate-to-severe mitral stenosis or a mechanical heart valve, were aged ≥65 years and prescribed OAC on or after 10/1/2015 through 2019 were included. Delayed and early OAC initiation were defined as >3 months and 0-3 months initiation from first AF diagnosis, respectively. Main outcome measures: Association between delayed OAC initiation and patient demographics, clinical and index OAC coverage and formulary characteristics was examined using multivariable logistic regression. Results: = 314,472) as early OAC initiation. Median age for both cohorts was 78 years. In the early and delayed OAC cohorts, 47.1 % and 47.6 % were male and 88.8 % and 86.6 %, were White, respectively. Factors associated with delayed OAC initiation (odds ratio; 95 % confidence interval) included Black race (1.29; 1.25 to 1.33), west region (1.29; 1.26 to 1.32), comorbidities such as dementia (1.27; 1.23 to 1.30), recent bleeding hospitalization (1.22; 1.18 to 1.27), prior authorization (1.69; 1.66 to 1.71), tier 4 formulary for index OAC at AF diagnosis (1.26; 1.22 to 1.30). Conclusion: Our study revealed that nearly one-third of Medicare patients with AF experienced delayed OAC initiation. Key patient characteristics found to be associated with delayed OAC initiation included race and ethnicity, comorbidities, and formulary restrictions.
No takes yet. Share an insight, caveat, or question.
Luo et al. (2024) conducted a cohort in Atrial Fibrillation (n=446,441). Prior authorization requirement for index OAC vs. No prior authorization requirement was evaluated on Delayed OAC initiation (>3 months from AF diagnosis) (OR 1.69, 95% CI 1.66-1.71, p=<0.05). A prior authorization requirement for the index oral anticoagulant was a strong predictor of delayed treatment initiation, increasing the odds of delay by 69% (OR 1.69).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: