Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study
Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalizatio...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027211 |
| _version_ | 1827572724050952192 |
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| author | Kuan Ken Lee Dimitrios Doudesis Rong Bing Federica Astengo Jesus R. Perez Atul Anand Shauna McIntyre Nicholas Bloor Belinda Sandler Steven Lister Kevin G. Pollock Ayesha C. Qureshi David A. McAllister Anoop S. V. Shah Nicholas L. Mills |
| author_facet | Kuan Ken Lee Dimitrios Doudesis Rong Bing Federica Astengo Jesus R. Perez Atul Anand Shauna McIntyre Nicholas Bloor Belinda Sandler Steven Lister Kevin G. Pollock Ayesha C. Qureshi David A. McAllister Anoop S. V. Shah Nicholas L. Mills |
| author_sort | Kuan Ken Lee |
| collection | DOAJ |
| description | Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotland were included in the present cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modeling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. A total of 172 989 patients (48% women [82 833 of 172 989]) had an incident hospitalization with nonvalvular AF in Scotland between 2010 and 2019. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared with men (adjusted odds ratio [aOR], 0.68 [95% CI, 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR, 0.68 [95% CI, 0.66–0.70]), while there was less disparity in the use of factor Xa inhibitors between women and men (aOR, 0.92 [95% CI, 0.90–0.95]). Conclusions Women with nonvalvular AF were significantly less likely to be prescribed vitamin K antagonists compared with men. Most patients admitted to the hospital in Scotland with incident nonvalvular AF are now treated with factor Xa inhibitors and this is associated with fewer treatment disparities between women and men. |
| first_indexed | 2024-03-07T19:21:40Z |
| format | Article |
| id | doaj.art-24f69a17b6e94ff09b6c7dba64669913 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T19:21:40Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-24f69a17b6e94ff09b6c7dba646699132024-02-29T10:25:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-03-0112510.1161/JAHA.122.027211Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort StudyKuan Ken Lee0Dimitrios Doudesis1Rong Bing2Federica Astengo3Jesus R. Perez4Atul Anand5Shauna McIntyre6Nicholas Bloor7Belinda Sandler8Steven Lister9Kevin G. Pollock10Ayesha C. Qureshi11David A. McAllister12Anoop S. V. Shah13Nicholas L. Mills14BHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomInstitute of Health and Wellbeing, University of Glasgow Glasgow United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBristol Myers Squibb Pharmaceuticals Ltd London United KingdomPfizer Ltd Tadworth United KingdomBristol Myers Squibb Pharmaceuticals Ltd London United KingdomBristol Myers Squibb Pharmaceuticals Ltd London United KingdomBristol Myers Squibb Pharmaceuticals Ltd London United KingdomBristol Myers Squibb Pharmaceuticals Ltd London United KingdomInstitute of Health and Wellbeing, University of Glasgow Glasgow United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBHF Centre for Cardiovascular Science University of Edinburgh Edinburgh United KingdomBackground Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotland were included in the present cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modeling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. A total of 172 989 patients (48% women [82 833 of 172 989]) had an incident hospitalization with nonvalvular AF in Scotland between 2010 and 2019. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared with men (adjusted odds ratio [aOR], 0.68 [95% CI, 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR, 0.68 [95% CI, 0.66–0.70]), while there was less disparity in the use of factor Xa inhibitors between women and men (aOR, 0.92 [95% CI, 0.90–0.95]). Conclusions Women with nonvalvular AF were significantly less likely to be prescribed vitamin K antagonists compared with men. Most patients admitted to the hospital in Scotland with incident nonvalvular AF are now treated with factor Xa inhibitors and this is associated with fewer treatment disparities between women and men.https://www.ahajournals.org/doi/10.1161/JAHA.122.027211atrial fibrillationoral anticoagulation therapysex differences |
| spellingShingle | Kuan Ken Lee Dimitrios Doudesis Rong Bing Federica Astengo Jesus R. Perez Atul Anand Shauna McIntyre Nicholas Bloor Belinda Sandler Steven Lister Kevin G. Pollock Ayesha C. Qureshi David A. McAllister Anoop S. V. Shah Nicholas L. Mills Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation oral anticoagulation therapy sex differences |
| title | Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study |
| title_full | Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study |
| title_fullStr | Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study |
| title_full_unstemmed | Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study |
| title_short | Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study |
| title_sort | sex differences in oral anticoagulation therapy in patients hospitalized with atrial fibrillation a nationwide cohort study |
| topic | atrial fibrillation oral anticoagulation therapy sex differences |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027211 |
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