Celina M Yong1, Yuyin Liu2, Patricia Apruzzese3, Gheorghe Doros2, Christopher P Cannon3, Thomas M Maddox4, Anil Gehi5, Jonathan C Hsu6, Steven A Lubitz7, Salim Virani8, Mintu P Turakhia9. 1. Stanford University School of Medicine (Stanford, CA); VA Palo Alto Health Care System, Palo Alto, CA. 2. Baim Institute for Clinical Research, Boston, CA; Department of Biostatistics, Boston University, Boston, CA. 3. Baim Institute for Clinical Research, Boston, CA. 4. Division of Cardiology, Washington University School of Medicine, St. Louis, MO. 5. University of North Carolina School of Medicine, Chapel Hill, NC). 6. UC San Diego, San Diego, CA. 7. Massachusetts General Hospital, Boston, MA. 8. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX. 9. Stanford University School of Medicine (Stanford, CA); VA Palo Alto Health Care System, Palo Alto, CA. Electronic address: mintu@stanford.edu.
Abstract
BACKGROUND: It is poorly understood whether insurance type may be a major contributor to the underuse of oral anticoagulation (OAC) among patients with atrial fibrillation (AF), particularly for novel oral anticoagulants (NOACs). METHODS: We performed a retrospective cohort registry study of patients with insurance, AF, CHA2DS2-VASc ≥2, and at least one outpatient encounter recorded in the ACC NCDR's PINNACLE Registry between January 1, 2011 and December 31, 2014. We used hierarchical regression, adjusting for patient characteristics and clustering by physician, to evaluate the association of insurance type (Private, Military, Medicare, Medicaid, Other) with receipt of OAC (any OAC, warfarin, or NOAC). RESULTS: In 363,309 patients (age 75±10; 48% female), we found a significant difference in proportions of OAC and NOAC prescription across insurance types (OAC: Military 53%, Private 53%, Medicare 52%, Other 41%, Medicaid 41%, P<.001; NOAC: Military 24%, Private 19%, Medicare 17%, Other 17%, Medicaid 8%, P<.001). After adjustment for patient characteristics and facility, private, Medicaid, and other insurance were independently associated with a lower odds of OAC prescription relative to Medicare, but military insured patients were not significantly different. After adjustment, military and private insurance were independently associated with a higher odds of NOAC prescription relative to Medicare, while Medicaid and other insurance were associated with a lower odds of NOAC prescription. CONCLUSIONS: In a contemporary US AF population, there was significant variation of OAC prescription across insurance plans, with the highest among private and Medicare insured patients. These differences may indicate that insurance plan, and its associated pharmacy benefits, affect the pace of diffusion of new therapies.
BACKGROUND: It is poorly understood whether insurance type may be a major contributor to the underuse of oral anticoagulation (OAC) among patients with atrial fibrillation (AF), particularly for novel oral anticoagulants (NOACs). METHODS: We performed a retrospective cohort registry study of patients with insurance, AF, CHA2DS2-VASc ≥2, and at least one outpatient encounter recorded in the ACC NCDR's PINNACLE Registry between January 1, 2011 and December 31, 2014. We used hierarchical regression, adjusting for patient characteristics and clustering by physician, to evaluate the association of insurance type (Private, Military, Medicare, Medicaid, Other) with receipt of OAC (any OAC, warfarin, or NOAC). RESULTS: In 363,309 patients (age 75±10; 48% female), we found a significant difference in proportions of OAC and NOAC prescription across insurance types (OAC: Military 53%, Private 53%, Medicare 52%, Other 41%, Medicaid 41%, P<.001; NOAC: Military 24%, Private 19%, Medicare 17%, Other 17%, Medicaid 8%, P<.001). After adjustment for patient characteristics and facility, private, Medicaid, and other insurance were independently associated with a lower odds of OAC prescription relative to Medicare, but military insured patients were not significantly different. After adjustment, military and private insurance were independently associated with a higher odds of NOAC prescription relative to Medicare, while Medicaid and other insurance were associated with a lower odds of NOAC prescription. CONCLUSIONS: In a contemporary US AF population, there was significant variation of OAC prescription across insurance plans, with the highest among private and Medicare insured patients. These differences may indicate that insurance plan, and its associated pharmacy benefits, affect the pace of diffusion of new therapies.
Authors: Andrew Young Chang; Mariam Askari; Jun Fan; Paul A Heidenreich; P Michael Ho; Kenneth W Mahaffey; Aditya Jathin Ullal; Alexander Carroll Perino; Mintu P Turakhia Journal: Clin Cardiol Date: 2018-09-22 Impact factor: 2.882
Authors: Iwona Gorczyca; Olga Jelonek; Beata Uziębło-Życzkowska; Magdalena Chrapek; Małgorzata Maciorowska; Maciej Wójcik; Robert Błaszczyk; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Tomasz Tokarek; Renata Rajtar-Salwa; Jacek Bil; Michał Wojewódzki; Anna Szpotowicz; Janusz Bednarski; Elwira Bakuła-Ostalska; Anna Tomaszuk-Kazberuk; Anna Szyszkowska; Marcin Wełnicki; Artur Mamcarz; Beata Wożakowska-Kapłon Journal: J Clin Med Date: 2020-11-05 Impact factor: 4.241
Authors: Bernadetta Bielecka; Iwona Gorczyca-Głowacka; Beata Wożakowska-Kapłon Journal: Int J Environ Res Public Health Date: 2022-09-21 Impact factor: 4.614
Authors: Celina M Yong; Jennifer A Tremmel; Maarten G Lansberg; Jun Fan; Mariam Askari; Mintu P Turakhia Journal: J Am Heart Assoc Date: 2020-05-12 Impact factor: 5.501