Abstract 16693: Trends in the Use of Oral Anticoagulation for Nonvalvular Atrial Fibrillation Vary by Specialty: Real World Results From a Large Integrated Health Care System 2011-2022

Abstract

Introduction: Direct Oral anticoagulants (DOACs) have demonstrated superiority or non inferiority to vitamin K antagonists (VKAs) for stroke/embolic prevention in patients with nonvalvular atrial fibrillation (NVAF). However, clinical inertia may delay widespread adoption of newer therapies in medicine. Hypothesis: We evaluated whether uptake of DOACs into clinical medicine varied by physician specialty. Methods: We performed a retrospective review of patients with NVAF within the Geisinger Health System from 2011-2022. Longitudinal yearly trends for new/initial prescriptions (Rx) of DOAC vs VKA by cardiology or primary care (PCP) specialties Results: We identified patients with NVAF initiated on an oral anticoagulant from the years 2011 through 2023. Figures 1 and 2 demonstrate a statistically significant linear yearly increase in new Rx for DOACs for both cardiology and PCP specialties.By 2022, DOACs currently account for 96% of all new oral anticoagulant Rx by cardiologists and 90% of Rx by PCP. New Rx for DOAC by PCP lagged cardiology at all time points. Cardiology initial Rx >50% DOAC by 2015 while PCP did not achieve this mark until 2018. Conclusions: In this real-world setting, we observed a significant increase in DOAC use as the initial prescription for patients with NVAF by both cardiology and primary care specialties.Significant difference in the adoption of DOAC was noted between cardiology and primary care specialties.Primary care use of DOAC as first Rx for NVAF increased over time but lagged cardiology by 2-3 years.