Abstract 268: Trends and Predictors of Novel Oral Anticoagulant versus Warfarin Use in Patients With Non-valvular Atrial Fibrillation: Opportunities for Improving Care

Abstract

Objectives: While NOACs are known to have an excellent safety profile, providers have historically been cautious when prescribing this medication class to specific patient populations, including those with a low GFR, advanced age, elevated bleeding risk, and a history of CAD. This study aims to examine the role of patient demographics, comorbid conditions, and health indices on anticoagulant prescribing practices with hopes to identify patient populations for which we have not yet maximized the use of NOACs in clinical practice. Methods: We performed a retrospective analysis looking specifically at a cohort of all outpatients in a large health system from 2010 to 2019 who were newly diagnosed with NVAF. The data was then split into an early versus contemporary NOAC era defined as when the incidence of NOAC prescriptions surpassed that of Warfarin. Patient demographics, comorbid conditions, and health indices were then analyzed to elucidate which of these factors most influence anticoagulant selection. Finally, we examined how the influence of these factors had changed over time. Results: Our sample consisted of 19,989 patients; 7606 on Warfarin and 12,383 on a NOAC. The early-NOAC cohort consisted of 6041 patients; 4143 on Warfarin and 1458 on a NOAC. The contemporary-NOAC cohort consisted of 13,948 patients; 3463 on Warfarin and 10,925 on a NOAC. Table 1 illustrates the adjusted odds ratios for NOAC versus Warfarin selection. Overall, the most significant predictors of AC selection were patient age, income, insurance type, and history of coronary artery disease, diabetes, and systolic heart failure. Conclusions: We have identified changes over time in anticoagulant prescribing practices for NVAF. Factors such as advanced age and a history of major bleeding have shown a shift towards NOACs, which is consistent with the evidence in the literature supporting NOACs’ safety in these populations. On the other hand, irrespective of mounting evidence that NOACs are safe in patients with a low GFR or a history of CAD, our findings indicate that providers still favor Warfarin in these populations, suggesting that there is still an opportunity to improve our prescribing practices to provide the best high-quality, evidence-based care.