Treatment and discharge patterns among patients hospitalized with non-valvular atrial fibrillation transitioning from the inpatient to outpatient setting. (4th March 2018)

• Record Type: Journal Article
• Authors: Henk, Henry J.; Cao, Feng; Tuell, Kenneth; Price, Kwanza; Singh, Prianka; Mardekian, Jack; Odell, Kevin; Patel, Chad; Tan, Wilson; Sands, George H.; Singhal, Shalabh; Trocio, Jeffrey; Vo, Lien
• Is Part Of: Current medical research and opinion. Volume 34:Number 3(2018)
• Page Start: 539
• Page End: 546
• Publication Date: 2018-03-04
• Subjects: Atrial fibrillation -- warfarin -- oral anticoagulation -- direct oral anticoagulants -- transition of care; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2017.1417029
• Languages: English
• ISSNs: 0300-7995

Abstract

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.