Contemporary clinical and economic outcomes among oral anticoagulant treated and untreated elderly patients with atrial fibrillation: Insights from the United States Medicare database
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Key result
Oral anticoagulant treatment in elderly patients with atrial fibrillation was associated with a lower risk of stroke or systemic embolism (HR 0.70) compared to no treatment.
Why the study?
While oral anticoagulants mitigate stroke risk in AF, clinical and economic outcomes needed comparison between OAC-treated and untreated elderly AF patients.
Does oral anticoagulant therapy reduce stroke/systemic embolism and mortality in elderly patients with atrial fibrillation compared to no treatment?
Population
1,421,187 newly diagnosed elderly AF patients in the Medicare database
Comparison
OAC treated vs untreated
Design
Retrospective database cohort study
Authors
Discussion
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Member takes
Implication
OAC use may improve outcomes in elderly AF; leaves open causal confirmation and cost-effectiveness via RCTs.
Study Design
Type
Cohort (n=1,421,187)
Structured PICO
Does oral anticoagulant therapy reduce stroke/systemic embolism and mortality in elderly patients with atrial fibrillation compared to no treatment?
P
Population
1,421,187 elderly patients (aged ≥65 years) with newly diagnosed atrial fibrillation and a CHA2DS2-VASc score ≥2, identified in the US Medicare database.
E
Exposure
Oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin) initiated on or after the first atrial fibrillation diagnosis.
C
Comparator
No oral anticoagulant treatment during the follow-up period.
O
Outcome
Risk of stroke/systemic embolism (SE), major bleeding (MB), all-cause death, and total healthcare costs per patient per month.hard clinical
Main Result
Hazard Ratio: 0.7 (95% CI 0.68–0.72)
In a real-world elderly Medicare population, oral anticoagulant treatment for atrial fibrillation was associated with reduced stroke and mortality, and lower total healthcare costs, despite an increased risk of major bleeding.
Limitations
- Retrospective study design allows only for associations, not causations
- Coding errors and lack of granular clinical data (e.g., kidney disease staging)
- Over-the-counter aspirin use and laboratory data (INR) were not available
- Only evaluated the first episode of treatment
- Potential residual confounding
- Results may not be generalizable to patients without fee-for-service Medicare insurance
- Potential residual confounding as indicated by statistically significant falsification analysis for urinary tract infection hospitalizations
Cite This Study
Munir et al. (2022) conducted a cohort in Atrial fibrillation (n=1,421,187). Oral anticoagulants vs. No oral anticoagulant treatment was evaluated on Stroke/systemic embolism (SE) (HR 0.70, 95% CI 0.68-0.72). Oral anticoagulant treatment in elderly patients with atrial fibrillation was associated with a lower risk of stroke or systemic embolism (HR 0.70) compared to no treatment.
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