Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System
Background: Direct oral anticoagulants (DOACs) are a first-line anticoagulant therapy for eligible patients with atrial fibrillation. Prescribing differences in the Military Health System have not yet been assessed. Methods: We conducted a retrospective cross-sectional study using administrative cla...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602223000101 |
| _version_ | 1811166401205895168 |
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| author | William Hirschfeld Richele Corrado Amanda Banaag Jessica Korona-Bailey Tracey Perez Koehlmoos |
| author_facet | William Hirschfeld Richele Corrado Amanda Banaag Jessica Korona-Bailey Tracey Perez Koehlmoos |
| author_sort | William Hirschfeld |
| collection | DOAJ |
| description | Background: Direct oral anticoagulants (DOACs) are a first-line anticoagulant therapy for eligible patients with atrial fibrillation. Prescribing differences in the Military Health System have not yet been assessed. Methods: We conducted a retrospective cross-sectional study using administrative claims data from the Military Health System Data Repository from fiscal years 2018–2019. We identified TRICARE Prime and Prime Plus patients between the ages of 18 and 64 with a diagnosis of atrial fibrillation and a CHA2DS2-VASc score of ≥2. Descriptive statistics and odds of receiving DOACs by gender, age, race, and socioeconomic status were calculated. Results: A total of 5289 TRICARE Prime and Prime Plus patients within the Military Health System who carried a diagnosis of atrial fibrillation and a CHA2DS2-VASc ≥2 were identified. Of all patients, 2373 (40.71 %) were prescribed a DOAC whereas 287 (4.92 %) were prescribed warfarin within 90 days of diagnosis of atrial fibrillation. Black patients were significantly less likely to be prescribed a DOAC compared to White patients (adjusted odds ratio [aOR], 0.82; 95 % CI 0.68–0.99), as were females compared to males (aOR, 0.64; 95 % CI 0.52–0.79). Senior officers were significantly more likely to be prescribed a DOAC compared to senior enlisted service members (aOR, 0.64; 95 % CI 0.52–0.79). Conclusions: Our study shows that differences exist within the Military Health System in the prescription of DOACs for atrial fibrillation by race, gender, and socio-economic status. These differences cannot be explained by differences in access to insurance or cost of medications. |
| first_indexed | 2024-04-10T15:51:45Z |
| format | Article |
| id | doaj.art-66796f88d9c44cd8bb955cfec2d11887 |
| institution | Directory Open Access Journal |
| issn | 2666-6022 |
| language | English |
| last_indexed | 2024-04-10T15:51:45Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj.art-66796f88d9c44cd8bb955cfec2d118872023-02-11T04:16:33ZengElsevierAmerican Heart Journal Plus2666-60222023-02-0126100258Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health SystemWilliam Hirschfeld0Richele Corrado1Amanda Banaag2Jessica Korona-Bailey3Tracey Perez Koehlmoos4Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USADepartment of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USADepartment of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement in Military Medicine, Inc., Bethesda, MD 20817, USADepartment of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M. Jackson Foundation for the Advancement in Military Medicine, Inc., Bethesda, MD 20817, USA; Corresponding author at: 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USABackground: Direct oral anticoagulants (DOACs) are a first-line anticoagulant therapy for eligible patients with atrial fibrillation. Prescribing differences in the Military Health System have not yet been assessed. Methods: We conducted a retrospective cross-sectional study using administrative claims data from the Military Health System Data Repository from fiscal years 2018–2019. We identified TRICARE Prime and Prime Plus patients between the ages of 18 and 64 with a diagnosis of atrial fibrillation and a CHA2DS2-VASc score of ≥2. Descriptive statistics and odds of receiving DOACs by gender, age, race, and socioeconomic status were calculated. Results: A total of 5289 TRICARE Prime and Prime Plus patients within the Military Health System who carried a diagnosis of atrial fibrillation and a CHA2DS2-VASc ≥2 were identified. Of all patients, 2373 (40.71 %) were prescribed a DOAC whereas 287 (4.92 %) were prescribed warfarin within 90 days of diagnosis of atrial fibrillation. Black patients were significantly less likely to be prescribed a DOAC compared to White patients (adjusted odds ratio [aOR], 0.82; 95 % CI 0.68–0.99), as were females compared to males (aOR, 0.64; 95 % CI 0.52–0.79). Senior officers were significantly more likely to be prescribed a DOAC compared to senior enlisted service members (aOR, 0.64; 95 % CI 0.52–0.79). Conclusions: Our study shows that differences exist within the Military Health System in the prescription of DOACs for atrial fibrillation by race, gender, and socio-economic status. These differences cannot be explained by differences in access to insurance or cost of medications.http://www.sciencedirect.com/science/article/pii/S2666602223000101Military medicineHealth systemsDirect oral anticoagulantsCardiologyHealth disparities |
| spellingShingle | William Hirschfeld Richele Corrado Amanda Banaag Jessica Korona-Bailey Tracey Perez Koehlmoos Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System American Heart Journal Plus Military medicine Health systems Direct oral anticoagulants Cardiology Health disparities |
| title | Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System |
| title_full | Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System |
| title_fullStr | Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System |
| title_full_unstemmed | Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System |
| title_short | Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System |
| title_sort | identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the military health system |
| topic | Military medicine Health systems Direct oral anticoagulants Cardiology Health disparities |
| url | http://www.sciencedirect.com/science/article/pii/S2666602223000101 |
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