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Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants

IMPORTANCE: There are no data on patient-centered outcomes and health care costs by frailty in patients with atrial fibrillation (AF) taking oral anticoagulants (OACs). OBJECTIVE: To compare home time, clinical events, and health care costs associated with OACs by frailty levels in older adults with...

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Autores principales: Lin, Kueiyu Joshua, Singer, Daniel E., Ko, Darae, Glynn, Robert, Najafzadeh, Mehdi, Lee, Su Been, Bessette, Lily Gui, Cervone, Alexander, DiCesare, Elyse, Kim, Dae Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636636/
https://www.ncbi.nlm.nih.gov/pubmed/37943558
http://dx.doi.org/10.1001/jamanetworkopen.2023.42264
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author Lin, Kueiyu Joshua
Singer, Daniel E.
Ko, Darae
Glynn, Robert
Najafzadeh, Mehdi
Lee, Su Been
Bessette, Lily Gui
Cervone, Alexander
DiCesare, Elyse
Kim, Dae Hyun
author_facet Lin, Kueiyu Joshua
Singer, Daniel E.
Ko, Darae
Glynn, Robert
Najafzadeh, Mehdi
Lee, Su Been
Bessette, Lily Gui
Cervone, Alexander
DiCesare, Elyse
Kim, Dae Hyun
author_sort Lin, Kueiyu Joshua
collection PubMed
description IMPORTANCE: There are no data on patient-centered outcomes and health care costs by frailty in patients with atrial fibrillation (AF) taking oral anticoagulants (OACs). OBJECTIVE: To compare home time, clinical events, and health care costs associated with OACs by frailty levels in older adults with AF. DESIGN, SETTING, AND PARTICIPANTS: This community-based cohort study assessed Medicare fee-for-service beneficiaries 65 years or older with AF from January 1, 2013, to December 31, 2019. Data analysis was performed from January to December 2022. EXPOSURES: Apixaban, rivaroxaban, and warfarin use were measured from prescription claims. Frailty was measured using a validated claims-based frailty index. MAIN OUTCOMES AND MEASURES: Outcome measures were (1) home time (days alive out of the hospital and skilled nursing facility) loss greater than 14 days; (2) a composite end point of ischemic stroke, systemic embolism, major bleeding, or death; and (3) total cost per member per year after propensity score overlap weighting. RESULTS: The weighted population comprised 136 551 beneficiaries, including 45 950 taking apixaban (mean [SD] age, 77.6 [7.3] years; 51.3% female), 45 320 taking rivaroxaban (mean [SD] age, 77.6 [7.3] years; 51.9% female), and 45 281 taking warfarin (mean [SD] age, 77.6 [7.3] years; 52.0% female). Compared with apixaban, rivaroxaban was associated with increased risk of home time lost greater than 14 days (risk difference per 100 persons, 1.8 [95% CI, 1.5-2.1]), composite end point (rate difference per 1000 person-years, 21.3 [95% CI, 16.4-26.2]), and total cost (mean difference, $890 [95% CI, $652-$1127]), with greater differences among the beneficiaries with frailty. Use of warfarin relative to apixaban was associated with increased home time lost (risk difference per 100 persons, 3.2 [95% CI, 2.9-3.5]) and composite end point (rate difference per 1000 person-years, 29.4 [95% CI, 24.5-34.3]), with greater differences among the beneficiaries with frailty. Compared with apixaban, warfarin was associated with lower total cost (mean difference, −$1166 [95% CI, −$1396 to −$937]) but higher cost when excluding OAC cost (mean difference, $1409 [95% CI, $1177 to $1642]) regardless of frailty levels. CONCLUSIONS AND RELEVANCE: In older adults with AF, apixaban was associated with increased home time and lower rates of clinical events than rivaroxaban and warfarin, especially for those with frailty. Apixaban was associated with lower total cost compared with rivaroxaban but higher cost compared with warfarin due to higher OAC cost. These findings suggest that apixaban may be preferred for older adults with AF, particularly those with frailty.
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spelling pubmed-106366362023-11-15 Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants Lin, Kueiyu Joshua Singer, Daniel E. Ko, Darae Glynn, Robert Najafzadeh, Mehdi Lee, Su Been Bessette, Lily Gui Cervone, Alexander DiCesare, Elyse Kim, Dae Hyun JAMA Netw Open Original Investigation IMPORTANCE: There are no data on patient-centered outcomes and health care costs by frailty in patients with atrial fibrillation (AF) taking oral anticoagulants (OACs). OBJECTIVE: To compare home time, clinical events, and health care costs associated with OACs by frailty levels in older adults with AF. DESIGN, SETTING, AND PARTICIPANTS: This community-based cohort study assessed Medicare fee-for-service beneficiaries 65 years or older with AF from January 1, 2013, to December 31, 2019. Data analysis was performed from January to December 2022. EXPOSURES: Apixaban, rivaroxaban, and warfarin use were measured from prescription claims. Frailty was measured using a validated claims-based frailty index. MAIN OUTCOMES AND MEASURES: Outcome measures were (1) home time (days alive out of the hospital and skilled nursing facility) loss greater than 14 days; (2) a composite end point of ischemic stroke, systemic embolism, major bleeding, or death; and (3) total cost per member per year after propensity score overlap weighting. RESULTS: The weighted population comprised 136 551 beneficiaries, including 45 950 taking apixaban (mean [SD] age, 77.6 [7.3] years; 51.3% female), 45 320 taking rivaroxaban (mean [SD] age, 77.6 [7.3] years; 51.9% female), and 45 281 taking warfarin (mean [SD] age, 77.6 [7.3] years; 52.0% female). Compared with apixaban, rivaroxaban was associated with increased risk of home time lost greater than 14 days (risk difference per 100 persons, 1.8 [95% CI, 1.5-2.1]), composite end point (rate difference per 1000 person-years, 21.3 [95% CI, 16.4-26.2]), and total cost (mean difference, $890 [95% CI, $652-$1127]), with greater differences among the beneficiaries with frailty. Use of warfarin relative to apixaban was associated with increased home time lost (risk difference per 100 persons, 3.2 [95% CI, 2.9-3.5]) and composite end point (rate difference per 1000 person-years, 29.4 [95% CI, 24.5-34.3]), with greater differences among the beneficiaries with frailty. Compared with apixaban, warfarin was associated with lower total cost (mean difference, −$1166 [95% CI, −$1396 to −$937]) but higher cost when excluding OAC cost (mean difference, $1409 [95% CI, $1177 to $1642]) regardless of frailty levels. CONCLUSIONS AND RELEVANCE: In older adults with AF, apixaban was associated with increased home time and lower rates of clinical events than rivaroxaban and warfarin, especially for those with frailty. Apixaban was associated with lower total cost compared with rivaroxaban but higher cost compared with warfarin due to higher OAC cost. These findings suggest that apixaban may be preferred for older adults with AF, particularly those with frailty. American Medical Association 2023-11-09 /pmc/articles/PMC10636636/ /pubmed/37943558 http://dx.doi.org/10.1001/jamanetworkopen.2023.42264 Text en Copyright 2023 Lin KJ et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Lin, Kueiyu Joshua
Singer, Daniel E.
Ko, Darae
Glynn, Robert
Najafzadeh, Mehdi
Lee, Su Been
Bessette, Lily Gui
Cervone, Alexander
DiCesare, Elyse
Kim, Dae Hyun
Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title_full Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title_fullStr Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title_full_unstemmed Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title_short Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants
title_sort frailty, home time, and health care costs in older adults with atrial fibrillation receiving oral anticoagulants
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636636/
https://www.ncbi.nlm.nih.gov/pubmed/37943558
http://dx.doi.org/10.1001/jamanetworkopen.2023.42264
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