Sex differences in oral anticoagulation therapy in patients hospitalized with atrial fibrillation: a nationwide cohort study

Lee, K. K. et al. (2023) Sex differences in oral anticoagulation therapy in patients hospitalized with atrial fibrillation: a nationwide cohort study. Journal of the American Heart Association, 12(5), e027211. (doi: 10.1161/JAHA.122.027211) (PMID:36864741) (PMCID:PMC10111444)

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Abstract

Background: Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results: All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotland were included in the present cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modeling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. A total of 172 989 patients (48% women [82 833 of 172 989]) had an incident hospitalization with nonvalvular AF in Scotland between 2010 and 2019. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared with men (adjusted odds ratio [aOR], 0.68 [95% CI, 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR, 0.68 [95% CI, 0.66–0.70]), while there was less disparity in the use of factor Xa inhibitors between women and men (aOR, 0.92 [95% CI, 0.90–0.95]). Conclusions: Women with nonvalvular AF were significantly less likely to be prescribed vitamin K antagonists compared with men. Most patients admitted to the hospital in Scotland with incident nonvalvular AF are now treated with factor Xa inhibitors and this is associated with fewer treatment disparities between women and men.

Item Type:Articles
Additional Information:This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023), and a Research Excellence Award (RE/18/5/34216). D.A.M. is funded by a Wellcome Trust Intermediate Clinical Fellowship (201492/Z/16/Z). This study was also supported by a research grant to LHS Lothian from Bristol Myers Squibb Pharmaceuticals Ltd and Pfizer UK Ltd.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David
Authors: Lee, K. K., Doudesis, D., Bing, R., Astengo, F., Perez, J. R., Anand, A., McIntyre, S., Bloor, N., Sandler, B., Lister, S., Pollock, K. G., Qureshi, A. C., McAllister, D. A., Shah, A. S.V., and Mills, N. L.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Published Online:02 March 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in Journal of the American Heart Association 12(5): e027211
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
173492Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZInstitute of Health & Wellbeing