Evaluation of the treatment patterns among commercially insured patients with nonvalvular atrial fibrillation prescribed an oral anticoagulant by race/ethnicity.

Aim: Despite evidence of racial/ethnicity health inequities in oral anticoagulant initiation and clinical outcomes for nonvalvular atrial fibrillation, little is known about disparities in treatment patterns, particularly discontinuation and switching. Materials & methods: This retrospective study utilized Komodo Healthcare Map data (1 July 2018 to 30 June 2023) to examine treatment patterns in patients with nonvalvular atrial fibrillation initiating direct oral anticoagulants (DOACs: apixaban, rivaroxaban, dabigatran) versus warfarin, stratified by self-reported race/ethnicity (White, Black and Hispanic) in the USA. Inverse probability of treatment weighting balanced baseline covariates and Cox model computed adjusted hazard ratio (aHR) and 95% confidence interval (CI) for apixaban-warfarin and DOAC-warfarin comparisons in the overall cohort and by race/ethnicity.

Results

In the apixaban-warfarin cohort, apixaban patients were 24% less likely to discontinue treatment (aHR: 0.76, 95% CI: 0.75-0.77) and 79% less likely to switch to another oral anticoagulant (aHR: 0.21, 95% CI: 0.20-0.22) versus warfarin. By race/ethnicity, a higher proportion of Black patients discontinued than White and Hispanic (68, 60 and 63%, respectively). Almost 5% of apixaban patients switched to another oral anticoagulant versus 31% on warfarin. Among warfarin switchers, 77% initiated apixaban (80% in White; 76% Black; 76% in Hispanic patients). The DOAC-warfarin cohort followed similar trends.

Conclusion

Overall, apixaban/DOACs were associated with more favorable treatment patterns than warfarin. However, racial/ethnicity differences were observed. Given the potential impact of oral anticoagulant discontinuation on clinical outcomes, further research is needed to better understand factors contributing to higher discontinuation and switch rates, particularly among Black and Hispanic patients.