Treatment and discharge patterns among patients hospitalized with non-valvular atrial fibrillation transitioning from the inpatient to outpatient setting

Abstract

Objective: To evaluate inpatient oral anticoagulant (OAC) treatment, discharge location, and post-discharge OAC treatment for patients hospitalized with non-valvular atrial fibrillation (NVAF).

Research design and methods: Retrospective study using claims data linked to hospital electronic health records (EHR). Patients (n = 2,484) were hospitalized with a primary (38%) or secondary (62%) diagnosis of AF without evidence of mitral valvular heart disease or valve replacement between January 2009 and September 2013. Inpatient OAC treatment was identified from EHR data.

Main outcome measures: Inpatient and post-discharge OAC treatment [direct OAC (DOAC; apixaban, rivaroxaban, dabigatran), warfarin, no OAC] and discharge location (long-term care, home health-care, home self-care).

Results: Mean age was 72.6 years, 61.2% were male, and 89.5% had a CHA2DS2-VASc score ≥2. Overall, 6.4% received a DOAC, 38.0% warfarin, and 55.6% no OAC during hospitalization. Compared to other treatment groups, patients receiving DOAC were younger and more likely to be male. The majority (72.2%) were discharged to home health-care, 13.2% home self-care, and 6.0% long-term care. Among patients who were treated with warfarin during hospitalization, 40.3% filled a warfarin prescription within 30 days post-discharge, whereas among patients who were treated with a DOAC, 52.4% filled a DOAC prescription within 30 days post-discharge. Some NVAF patients not treated with an OAC during hospitalization filled a prescription for warfarin (18.0%) or DOAC (1.9%) within 30 days post-discharge. Results were similar among patients with CHA2DS2-VASc score ≥2.

Conclusions: Most patients hospitalized for NVAF were discharged to home support, and the majority did not have OAC treatment during hospitalization or the 30 days post-discharge. Additional investigation should be conducted on trends beyond 30 days post-hospitalization, and the reasons for not receiving anticoagulation therapy in patients at moderate-to-severe risk of stroke or systemic embolism. Helping to avoid preventable strokes is an important goal for public health.

Keywords:

• Atrial fibrillation
• warfarin
• oral anticoagulation
• direct oral anticoagulants
• transition of care

Transparency

Declaration of funding

This study was sponsored by Bristol-Myers Squibb and Pfizer.

Declaration of financial/other relationships

K. Tuell, P. Singh, C. Patel, L. Vo, and S. Singhal are employed by Bristol-Myers Squibb. K. Price, J. Mardekian, K. Odell, W. Tan, G. H. Sands, and J. Trocio were employed by Pfizer at the time the study was conducted (W. Tan and K. Price are no longer employed by Pfizer). F. Cao and H. Henk are employees of Optum, whose health economics and outcomes consultancy was retained to conduct the study on which this manuscript was based. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to thank Jenifer Wogen, MedMentis Consulting LLC, for her medical writing assistance. Ms Wogen was compensated by Optum for her role in manuscript preparation.

Previous presentations

Portions of this study were presented at the American College of Cardiology’s 65th Annual Scientific Session, April 2–4, 2016, Chicago, IL; and the CHEST Annual Meeting, October 24–28, 2015, Montreal, Quebec, Canada.