Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice
Background The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new‐onset postoperative atrial fibrillation (POAF), and compare with patients newly diagnosed with non‐POAF. Methods and Results This retrospect...
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Wiley
2024-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035708 |
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| author | Xiaoxi Yao Holly K. Van Houten Konstantinos C. Siontis Paul A. Friedman Robert D. McBane Bernard J. Gersh Peter A. Noseworthy |
| author_facet | Xiaoxi Yao Holly K. Van Houten Konstantinos C. Siontis Paul A. Friedman Robert D. McBane Bernard J. Gersh Peter A. Noseworthy |
| author_sort | Xiaoxi Yao |
| collection | DOAJ |
| description | Background The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new‐onset postoperative atrial fibrillation (POAF), and compare with patients newly diagnosed with non‐POAF. Methods and Results This retrospective cohort study identified patients newly diagnosed with atrial fibrillation or flutter between 2012 and 2021 using administrative claims data from OptumLabs Data Warehouse. The POAF cohort included 118 366 patients newly diagnosed with atrial fibrillation or flutter within 30 days after surgery. The non‐POAF cohort included the remaining 315 832 patients who were newly diagnosed with atrial fibrillation or flutter but not within 30 days after a surgery. OAC initiation increased from 28.9% to 44.0% from 2012 to 2021 in POAF, and 37.8% to 59.9% in non‐POAF; 12‐month medication adherence increased from 47.0% to 61.8% in POAF, and 59.7% to 70.4% in non‐POAF. The median time to OAC discontinuation was 177 days for POAF, and 242 days for non‐POAF. Patients who saw a cardiologist within 90 days of the first atrial fibrillation or flutter diagnosis, regardless of POAF or non‐POAF, were more likely to initiate OAC (odds ratio, 2.92 [95% CI, 2.87–2.98]; P <0.0001), adhere to OAC (odds ratio, 1.08 [95% CI, 1.04–1.13]; P <0.0001), and less likely to discontinue (odds ratio, 0.83 [95% CI, 0.82–0.85]; P <0.0001) than patients who saw a surgeon or other specialties. Conclusions The use of and adherence to OAC were higher in non‐POAF patients than in POAF patients, but they increased over time in both groups. Patients managed by cardiologists were more likely to use and adhere to OAC, regardless of POAF or non‐POAF. |
| format | Article |
| id | doaj-art-fb89eb16ec834e29830684dce23dcee8 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-fb89eb16ec834e29830684dce23dcee82025-08-20T02:26:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-07-01131310.1161/JAHA.124.035708Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical PracticeXiaoxi Yao0Holly K. Van Houten1Konstantinos C. Siontis2Paul A. Friedman3Robert D. McBane4Bernard J. Gersh5Peter A. Noseworthy6Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester MNRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNBackground The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new‐onset postoperative atrial fibrillation (POAF), and compare with patients newly diagnosed with non‐POAF. Methods and Results This retrospective cohort study identified patients newly diagnosed with atrial fibrillation or flutter between 2012 and 2021 using administrative claims data from OptumLabs Data Warehouse. The POAF cohort included 118 366 patients newly diagnosed with atrial fibrillation or flutter within 30 days after surgery. The non‐POAF cohort included the remaining 315 832 patients who were newly diagnosed with atrial fibrillation or flutter but not within 30 days after a surgery. OAC initiation increased from 28.9% to 44.0% from 2012 to 2021 in POAF, and 37.8% to 59.9% in non‐POAF; 12‐month medication adherence increased from 47.0% to 61.8% in POAF, and 59.7% to 70.4% in non‐POAF. The median time to OAC discontinuation was 177 days for POAF, and 242 days for non‐POAF. Patients who saw a cardiologist within 90 days of the first atrial fibrillation or flutter diagnosis, regardless of POAF or non‐POAF, were more likely to initiate OAC (odds ratio, 2.92 [95% CI, 2.87–2.98]; P <0.0001), adhere to OAC (odds ratio, 1.08 [95% CI, 1.04–1.13]; P <0.0001), and less likely to discontinue (odds ratio, 0.83 [95% CI, 0.82–0.85]; P <0.0001) than patients who saw a surgeon or other specialties. Conclusions The use of and adherence to OAC were higher in non‐POAF patients than in POAF patients, but they increased over time in both groups. Patients managed by cardiologists were more likely to use and adhere to OAC, regardless of POAF or non‐POAF.https://www.ahajournals.org/doi/10.1161/JAHA.124.035708adherenceoral anticoagulationpostoperative atrial fibrillation |
| spellingShingle | Xiaoxi Yao Holly K. Van Houten Konstantinos C. Siontis Paul A. Friedman Robert D. McBane Bernard J. Gersh Peter A. Noseworthy Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adherence oral anticoagulation postoperative atrial fibrillation |
| title | Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice |
| title_full | Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice |
| title_fullStr | Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice |
| title_full_unstemmed | Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice |
| title_short | Ten‐Year Trend of Oral Anticoagulation Use in Postoperative and Nonpostoperative Atrial Fibrillation in Routine Clinical Practice |
| title_sort | ten year trend of oral anticoagulation use in postoperative and nonpostoperative atrial fibrillation in routine clinical practice |
| topic | adherence oral anticoagulation postoperative atrial fibrillation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035708 |
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