Impact of insurance coverage for non-vitamin K antagonist oral anticoagulants on quality of care and care disparities in patients hospitalised with atrial fibrillation in tertiary hospitals in China: interrupted time series analysis.

OBJECTIVE

To examine recent patterns regarding oral anticoagulant (OAC) use among patients hospitalised with atrial fibrillation (AF) and quantify the impact of insurance coverage for non-vitamin K oral anticoagulants (NOACs) on quality of care and care inequality regarding OAC use among hospitalised patients with AF.

DESIGN

Interrupted time series analysis.

SETTING

Hospitals in China.

PARTICIPANTS

A total of 36 393 patients hospitalised with non-valvular AF were involved between 2015 and 2019 across China.

PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome was the impact of insurance coverage for NOACs on quality of care regarding OAC prescription using interrupted time series analysis with segmented regression models.

RESULTS

OAC prescription rate during hospitalisation was 52.1% (31.3% for warfarin and 20.8% for NOACs) in patients with high-risk AF and 66.3% (29.8% for warfarin and 36.5% for NOACs) in low-risk patients. Insurance coverage for NOACs was associated with an immediate 10.9% (95% CI 7.6% to 14.3%) increase in NOAC prescription and a 0.33% (95% CI 0.08% to 0.58%) increase in the slope of the secular trend of NOAC prescription among all the patients. Disparities in NOAC prescription among hospitals decreased from 18.9 before the insurance coverage for NOACs to 3.4 after that. Similar results were found in patients with high risk of stroke.

CONCLUSION

A large gap exists between clinical practice and guideline recommendations regarding OAC prescription among patients hospitalised with AF in China. Insurance coverage may be an effective healthcare strategy to improve quality of care and reduce care disparities regarding OAC prescription among patients with AF.

TRIAL REGISTRATION NUMBER: NCT02309398.