Abstract P634: Contemporary Trends of Oral Anticoagulant Utilization Among Texas Medicare Beneficiaries With Atrial Fibrillation

Abstract

Introductions: Underutilization of oral anticoagulation (OAC) drugs among atrial fibrillation (AF) patients has been reported. We provide contemporary trends for utilization of warfarin and novel OACs (NOACs) among Medicare beneficiaries with AF in Texas. Methods: Using Texas Medicare Fee-for-Service claims data for 2014-2017, AF patients were identified if they had at least one inpatient or two outpatient claims with a diagnosis of AF using ICD 9/10 codes. AF patients having any medical claims with ICD 9/10 or CPT codes indicating vulvar stenosis or the presence of valve replacement were excluded. OACs included warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban and the use of a drug was assumed if the prescription was filled. The percentage of patients on OAC among AF patients, who were enrolled in Medicare Part D in the measurement year were reported with 95% CI and p-value for trends both overall and by CHA 2 DS 2 -VASc score and renal function. Results: Of 216,602 AF patients, 57% did not receive any OAC during any measurement year. Overall OAC utilization increased from 35.8% (35.4-36.2) in 2014 to 41.6 % (41.3-41.8) in 2017 (p <0.001). This increase was driven by NOAC use which increased from 18.6% (18.3-18.9) in 2014 to 29.3% (29.0-29.5) in 2017 (p <0.001) while the proportion of warfarin users decreased from 17.2% (16.9-17.5) in 2014 to 12.3% (12.1-12.5) in 2017 (p <0.001). Increasing trends for NOAC use and decreasing trends for warfarin were observed regardless of CHA 2 DS 2 -VASc scores and levels of renal function. Conclusions: The OAC use has been increasing but about 6 out of 10 AF patients do not receive OAC despite high CHA 2 DS 2 -VASc scores. Targeted strategies are required to address OAC underutilization among AF patients.