Clinical Characteristics, Oral Anticoagulation Patterns, and Outcomes of Medicaid Patients With Atrial Fibrillation: Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I) Registry.
Abstract
BACKGROUND: Whereas insurance status has been previously associated with care patterns,
little is currently known about the association between Medicaid insurance and the
clinical characteristics, treatment, or outcomes of patients with atrial fibrillation
(AF). METHODS AND RESULTS: We used data from adults with AF enrolled in the Outcomes
Registry for Better Informed Treatment of AF (ORBIT-AF), a national outpatient registry
conducted at 176 community, multispecialty sites. The primary outcome of interest
was the proportion of patients prescribed any oral anticoagulation (OAC; warfarin
or novel oral anticoagulants [NOAC]). Secondary outcomes of interest included the
proportion of patients prescribed NOACs (dabigatran or rivaroxaban); time in therapeutic
range (TTR) for warfarin users, all-cause mortality, stroke/systemic embolism, and
major bleed. Of 10 133 patients, N=470 (4.6%) had Medicaid insurance. Medicaid patients
were similarly likely to receive OAC at baseline (72.8% vs 76.3%; unadjusted P=0.079),
but less likely to receive NOAC at baseline or follow-up (12.1% vs 16.3%; unadjusted
P=0.019). After risk adjustment, Medicaid status was associated with lower use of
OAC at baseline among patients with high stroke risk (odds ratio [OR]=0.68; 95% CI=0.49,
0.94), but was not associated with OAC use overall (OR=0.82; 95% CI=0.61, 1.09). Among
warfarin users, median TTR was lower among Medicaid patients (60% vs 68%; P<0.0001;
adjusted TTR difference, -2.9; 95% CI=-5.7, -0.2; P=0.04). Use of an NOAC over 2 years
of follow-up was not statistically different by insurance. Compared with non-Medicaid
patients, Medicaid patients had higher unadjusted rates of mortality, stroke/systemic
embolism, and major bleeding; however, these differences were attenuated following
adjustment for clinical characteristics. CONCLUSIONS: In a contemporary AF cohort,
use of OAC overall and use of NOACs were not significantly lower among Medicaid patients
relative to others. However, among warfarin users, Medicaid patients spent less time
in therapeutic range compared with those with other forms of insurance.
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https://hdl.handle.net/10161/14998Published Version (Please cite this version)
10.1161/JAHA.115.002721Publication Info
O'Brien, Emily C; Kim, Sunghee; Thomas, Laine; Fonarow, Gregg C; Kowey, Peter R; Mahaffey,
Kenneth W; ... Peterson, Eric D (2016). Clinical Characteristics, Oral Anticoagulation Patterns, and Outcomes of Medicaid
Patients With Atrial Fibrillation: Insights From the Outcomes Registry for Better
Informed Treatment of Atrial Fibrillation (ORBIT-AF I) Registry. J Am Heart Assoc, 5(5). 10.1161/JAHA.115.002721. Retrieved from https://hdl.handle.net/10161/14998.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Emily O'Brien
Associate Professor in Population Health Sciences
I am an epidemiologist and health services researcher at the Duke Clinical Research
Institute. My research focuses on comparative effectiveness, patient-centered outcomes,
and pragmatic health services research in cardiovascular and pulmonary disease.Areas
of expertise: Epidemiology, Health Services Research, and Clinical Decision Sciences
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Professor of Medicine at Duke University Medical Center and the Duke Clinical
Research Institute. He is the Director of the Cardiac Electrophysiology section at
the Duke Heart Center. His focus is on the care of patients with atrial fibrillation
and complex arrhythmias, with particular emphasis on catheter ablation and lead extraction.
His research interests include the development and evaluation of i
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
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