Closeup image of older adult patient in bed being checked by doctor with stethoscope; Credit: Getty Images

Many older adults with atrial fibrillation remain undertreated with oral anticoagulants — despite the availability of new and better drugs that help prevent stroke, according to a new study.

Investigators used administrative claims data from Optum’s Clinformatics Data Mart to track initiation and adherence to OACs in between 2010 to 2020. Participants were Medicare Advantage beneficiaries with atrial fibrillation and a high risk of ischemic stroke. 

The 2010 advent of direct oral anticoagulants (DOACs) was expected to improve the uptake of anticoagulant drugs in Afib patients. These newer drugs are often safer and more effective than warfarin, the historic standard treatment. In fact, the 12-month rate of initiation of DOACs among all newly diagnosed older adult patients rose by nearly 13% between 2010 to 2020, particularly in patients with a high risk of bleeding, investigators found. In addition, patient adherence to these drugs improved during that time, with the apixaban now the most widely prescribed.

Practice gap evident

Yet a “persistent practice gap” is evident, wrote Dae Hyun Kim, MD, of Brigham and Women’s Hospital and Hebrew Senior Life in Boston. In fact, 47% of Medicare fee-for-service beneficiaries in 2016 and 67% of Medicare Advantage plan beneficiaries in 2020 did not receive any OAC after their Afib diagnosis or within 12 months.

And among patients aged 65 and older with dementia, frailty and anemia, initiation of OACs has remained “suboptimal,” likely due to elevated risks of bleeding in older patients, the authors wrote.

“These findings suggest that stroke prophylaxis using oral anticoagulation for [Afib] has improved in the past decade, but older adults with [Afib] and coexisting dementia, frailty and anemia remain undertreated,” they concluded.

The researchers referred readers to recommendations for effective and safe OAC initiation in patients with Afib and high bleeding risk. They also point to ongoing phase 2 clinical trials of a new class of anticoagulants that may reduce bleeding risk and address “this large, unmet clinical need.”

Full findings were published Friday, Nov. 18, in JAMA Network Open.

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