Demographic and Socio-Economic Disparities in the Outcomes Among Patients with NVAF Treated with Oral Anticoagulants: A Real-World Evaluation of Medicare Beneficiaries.

Objectives

To assess the association between apixaban use and the risk of stroke/systemic embolism (SE) and major bleeding (MB) compared with other anticoagulants (OACs) across demographic and socio-economic subgroups in the treatment of nonvalvular atrial fibrillation (NVAF).

Methods

The study included adult NVAF patients initiating OAC treatment between 2013 and 2019 in the Medicare database. Inverse probability treatment weighted Cox proportional hazard models were used to assess stroke/SE and MB outcomes across various subgroups.

Results

Overall, the adjusted risks of stroke/SE and MB were lower for apixaban compared with warfarin (stroke/SE: HR, 0.69, [95% confidence interval (CI): 0.65-0.74], MB: 0.59 [95% CI: 0.57-0.60]), rivaroxaban (stroke/SE: 0.88 [95% CI: 0.84-0.92], MB: 0.60 [95% CI: 0.58-0.61]) and dabigatran (stroke/SE: 0.88 [95% CI: 0.80-0.95], MB: 0.76 [95% CI: 0.72-0.80]). Among the low socio-economic status (SES) group, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.73 [95% CI: 0.69-0.77], MB: 0.60 [95% CI: 0.57-0.62]) and rivaroxaban (stroke/SE: 0.88 [95% CI: 0.83-0.94], MB: 0.61 [95% CI: 0.59-0.63]). Among medium SES patients, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.67 [95% CI: 0.63-0.71] MB: 0.60 [95% CI: 0.58-0.63]), rivaroxaban (stroke/SE: 0.85 [95% CI: 0.79-0.91], MB: 0.59 [95% CI: 0.56-0.61]) and dabigatran (stroke/SE: 0.85 [95% CI: 0.73-0.99], MB: 0.77 [95% CI: 0.70-0.84]). Apixaban was also associated with lower risks of stroke/SE and MB compared with other OACs among most other demographic, socio-economic subgroups.

Conclusions

Apixaban was associated with lower risk of stroke/SE and MB than warfarin, rivaroxaban, dabigatran across most demographic, socio-economic subgroups.