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. 2023 Jan 23:26:100258.
doi: 10.1016/j.ahjo.2023.100258. eCollection 2023 Feb.

Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System

William Hirschfeld  1 , Richele Corrado  1 , Amanda Banaag  2   3 , Jessica Korona-Bailey  2   3 , Tracey Perez Koehlmoos  2
Affiliations

Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System

William Hirschfeld et al. Am Heart J Plus. .

Abstract

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.

Keywords: Cardiology; Direct oral anticoagulants; Health disparities; Health systems; Military medicine.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Forest plot of select odds ratio results from multivariate logistic regression analysis for receipt of DOACs. This figure shows odds ratios from multivariate logistic regression for receipt of DOAC by gender, race, and socioeconomic status.
See this image and copyright information in PMC

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