ReviewJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2023
Oral anticoagulant underutilization among elderly patients with atrial fibrillation: insights from the United States Medicare database.
Review in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Decision Support Intervention and Anticoagulation for Emergency Department Atrial Fibrillation: The O'CAFÉ Stepped-Wedge Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Trends in the incidence of atrial fibrillation and the prescription of oral anticoagulants in adults with chronic obstructive pulmonary disease in UK primary care (2010-2022): a cohort study.EClinicalMedicine · 2026Article
- Untreated Atrial Fibrillation: Public Health Threat or Data Blind Spot?Journal of general internal medicine · 2026Article
- Association between first anticoagulant prescription and embolic and hemorrhagic events among older adults with atrial fibrillation.Journal of internal medicine · 2026Observational
- Oral anticoagulant timing and hospitalization in newly diagnosed nonvalvular atrial fibrillation patients.Frontiers in cardiovascular medicine · 2025Article
- A review of the use of oral anticoagulants in individuals with atrial fibrillation who had experienced intracranial hemorrhage in the past.International journal of physiology, pathophysiology and pharmacology · 2025Review
- Disparities in the real-world prescription pattern of oral anticoagulants for US Medicare beneficiaries: a geospatial analysis.BMJ open · 2024Article
- Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series.JACC. Cardiovascular interventions · 2024Review
- Risk scores for major bleeding from direct oral anticoagulants: comparing predictive performance in patients with atrial fibrillation.Research and practice in thrombosis and haemostasis · 2024Article
- Predictors of direct oral anticoagulant concentrations in the trauma population.Trauma surgery & acute care open · 2024Article
- Oral Anticoagulant Use in Patients with Atrial Fibrillation at Low Risk of Stroke and Associated Bleeding Complications.Journal of clinical medicine · 2023Article
- Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Review
- Anticoagulant Treatment in Patients with AF and Very High Thromboembolic Risk in the Era before and after the Introduction of NOAC: Observation at a Polish Reference Centre.International journal of environmental research and public health · 2023Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOral anticoagulants (OACs) mitigate stroke risk in patients with atrial fibrillation (AF). The study aim was to analyze prevalence and predictors of OAC underutilization.
methodsNewly diagnosed AF patients with a CHA
resultsAmong 1,204,507 identified AF patients, 617,611 patients (51.3%) were not prescribed an OAC during follow-up (mean: 2.4 years), and 586,896 patients (48.7%) were prescribed an OAC during this period (DOAC: 388,629 [66.2%]; warfarin: 198,267 [33.8%]). Age ≥ 85 years (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.55-0.56), female sex (OR 0.96, 95% CI 0.95-0.96), Black race (OR 0.78, 95% CI 0.77-0.79) and comorbidities such as gastrointestinal (GI; OR 0.43, 95% CI 0.41-0.44) and intracranial bleeding (OR 0.29, 95% CI 0.28-0.31) were associated with lower utilization of OACs. Furthermore, age ≥ 85 years (OR 0.92, 95% CI 0.91-0.94), Black race (OR 0.78, 95% CI 0.76-0.80), ischemic stroke (OR 0.77, 95% CI 0.75-0.80), GI bleeding (OR 0.73, 95% CI 0.68-0.77), and intracranial bleeding (OR 0.72, 95% CI 0.65-0.80) predicted lower use of DOACs versus warfarin.
conclusionsAlthough OAC therapy prescription is the standard of care for stroke prevention in AF patients, its overall utilization is still low among Medicare patients ≥ 65 years old, with specific patient characteristics that predict underutilization.
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