Abstract: SA-PO861
Long-Term Trends in Oral Anticoagulant (OAC) Use in US Patients with ESRD on Hemodialysis (HD) and Atrial Fibrillation (AF)
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hu, Austin, Baylor College of Medicine, Houston, Texas, United States
- Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
- Chang, Tara I., Stanford University School of Medicine , Palo Alto, California, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background
OACs are recommended for most patients with AF to prevent thromboembolic complications. Low OAC use has been reported in patients with ESRD on HD and AF. We tested whether OAC practices in this population have changed during the decade, 2006-2015.
Methods
From the USRDS, 2006-2015, we selected subsequent 6-month interval cohorts of Medicare-insured HD patients diagnosed with AF in the current or preceding intervals. From Medicare Part D claims we identified any warfarin or direct-target OAC use in each interval. Study outcomes were the prevalence of any OAC use, or use of specific agents. We used repeated measures logistic regression and interrupted time series analysis to 1) determine whether OAC use increased during 2006-2015, and 2) whether this longer-term trend changed after the approval of a labeled dose for apixaban in ESRD in Jan 2014.
Results
While the number of period-prevalent HD patients with AF increased from 33,052 (Jan-Jun 2006) to 63,675 (Jul-Dec 2015), the proportion receiving any OAC remained remarkably stable during the decade, at ~25% (Figure). There was a slight increase starting in 2014, which was mostly attributable to increasing apixaban use, with >27% of patients receiving OAC in Jul-Dec 2015, and apixaban representing 13% of all OAC use. Compared with Jul-Dec 2006, adjusted odds ratios were near unity throughout time, with an aOR of 1.07 (CI, 1.04-1.09) for any OAC and 0.96 (CI, 0.93-0.98) for warfarin use for Jul-Dec 2015. Adjusted interrupted time series analyses failed to reject the null hypothesis of a zero slope over the decade and did not identify a significant difference in level or slope for 2014-15 vs. 2006-2013, either.
Conclusion
The proportion of HD patients with AF receiving any OAC remained remarkably stable over the decade, at ~25%, with increasing substitution of warfarin by apixaban after 2014.
Funding
- NIDDK Support