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The American heart journal v.195, 2018년, pp.50 - 59   SCI SCIE
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Association of insurance type with receipt of oral anticoagulation in insured patients with atrial fibrillation: A report from the American College of Cardiology NCDR PINNACLE registry

Yong, Celina M. (Stanford University School of Medicine (Stanford, CA) ) ; Liu, Yuyin (Baim Institute for Clinical Research, Boston, CA ) ; Apruzzese, Patricia (Baim Institute for Clinical Research, Boston, CA ) ; Doros, Gheorghe (Baim Institute for Clinical Research, Boston, CA ) ; Cannon, Christopher P. (Baim Institute for Clinical Research, Boston, CA ) ; Maddox, Thomas M. (Division of Cardiology, Washington University School of Medicine, St. Louis, MO ) ; Gehi, Anil (University of North Carolina School of Medicine, Chapel Hill, NC) ) ; Hsu, Jonathan C. (UC San Diego, San Diego, CA ) ; Lubitz, Steven A. (Massachusetts General Hospital, Boston, MA ) ; Virani, Salim (Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX ) ; Turakhia, Mintu P. (Stanford University School of Medicine (Stanford, CA) ) ;
  • 초록  

    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, CHA 2 DS 2 -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 P 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.


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