Abstract 14004: Geographic and Racial Variation in Oral Anticoagulant Treatment Among Commercially Insured Patients With Non-Valvular Atrial Fibrillation in the United States

Abstract

Background: Oral anticoagulants (OACs) are recommended for non-valvular atrial fibrillation (NVAF) patients with high stroke risk. Guidelines endorse the use of direct oral anticoagulants (DOACs) over warfarin. Limited data exist on geographic variation in OAC use in the United States (US), particularly by race. Aim: To describe OAC utilization patterns among commercially insured NVAF patients with high stroke risk by geographic region and race. Methods: NVAF patients ≥18 years were identified from January 1, 2016, to August 31, 2021, in the Komodo claims database, which represents ≥140 million patients enrolled in US commercial health plans. Patients with ≥12 months of enrollment before and after NVAF diagnosis and with high stroke risk (defined as CHA 2 DS 2 -VASc Score ≥2) were included for analysis. Patients with other valvular diagnoses and/or procedures or pregnancy were excluded. Patients were classified based on treatment status as untreated, warfarin-treated, or DOAC-treated (apixaban/edoxaban/rivaroxaban/dabigatran). Results were stratified by geographic region and race (Black, White, other/unknown) and were visualized using SAS software. Results: After selection criteria, 619,111 NVAF patients with high stroke risk were identified with a mean age of 71 years. Over 50% of patients were untreated after NVAF diagnosis, and the untreated rate was highest in the South and West US regions. Additionally, the untreated rate was higher among Black patients than White patients (55% vs 49%, respectively). Of the treated, the overall rate of DOAC and warfarin use was 85% and 15%, respectively, with the highest rates observed in the Northeast for DOAC and Midwest for warfarin. DOAC use was lower among Black patients compared to White patients (Figure 1) . Conclusion: Among NVAF patients with high stroke risk, there are geographic and racial differences in OAC utilization that highlight areas of unmet need and opportunity for further research on these disparities.