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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.

dc.contributor.author Fonarow, GC
dc.contributor.author Gersh, Bernard John
dc.contributor.author Kim, S
dc.contributor.author Kowey, Peter R
dc.contributor.author Mahaffey, Kenneth William
dc.contributor.author O'Brien, Emily C
dc.contributor.author Peterson, Eric David
dc.contributor.author Piccini, Jonathan Paul Sr
dc.contributor.author Thomas, Laine Elliott
dc.coverage.spatial England
dc.date.accessioned 2017-07-06T14:07:12Z
dc.date.available 2017-07-06T14:07:12Z
dc.date.issued 2016-05-04
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/27146448
dc.identifier JAHA.115.002721
dc.identifier.uri http://hdl.handle.net/10161/14998
dc.description.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.
dc.language eng
dc.relation.ispartof J Am Heart Assoc
dc.relation.isversionof 10.1161/JAHA.115.002721
dc.subject Medicaid
dc.subject anticoagulation
dc.subject atrial fibrillation
dc.subject quality of care
dc.subject stroke prevention
dc.title 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.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/27146448
pubs.issue 5
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine, Clinical Pharmacology
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 5
dc.identifier.eissn 2047-9980


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