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November 11, 2018Health Services ResearchOpen Access

Guideline‐concordant initiation of oral anticoagulant therapy for stroke prevention in older veterans with atrial fibrillation eligible for Medicare Part D

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Population

6,619 elderly Veterans with a new episode of atrial fibrillation and high stroke risk initially diagnosed in…

Design

Cohort

Follow-up

90 days

Authors

NDNicolae DoneARAmanda M. RoyYYYingzhe Yuan

Discussion

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Overview

OAC underinitiation persists in one-third of high-risk AF Veterans, lower with Part D; leaves open insurance barriers and needs prospective confirmation.

Structured PICO

P
Population
6,619 elderly Veterans (age ≥66 years) with a new episode of atrial fibrillation and high stroke risk (CHA₂DS₂-VASc ≥2) initially diagnosed in the VHA, mean age 75.6, 98.2% male, eligible for Medicare.
I
Intervention
Oral anticoagulation (apixaban, dabigatran, rivaroxaban, edoxaban, or warfarin) initiation within 90 days of first AF diagnosis
O
Outcome
Guideline-concordant initiation of oral anticoagulation within 90 days of the first AF episode

One-third of elderly Veterans at high risk of stroke do not receive guideline-recommended oral anticoagulation within 90 days of atrial fibrillation diagnosis, with lower initiation rates among those enrolled in Medicare Part D.

Cite This Study

Done et al. (2018) studied this question.

synapsesocial.com/papers/6a821222d32bda7d52aa9ef9https://doi.org/10.1111/1475-6773.13079
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Underuse of anticoagulation in stroke patients with atrial fibrillation – the FibStroke Study2015 · 39 citations
  2. 2The use of warfarin in veterans with atrial fibrillation2004 · 19 citations
  3. 3Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation2016 · 459 citations
  4. 4Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation2017 · 229 citations
  5. 5Atrial Fibrillation, Stroke Risk, and Warfarin Therapy Revisited2013 · 345 citations