Oral Anticoagulant Timing and Hospitalization in Newly Diagnosed Nonvalvular Atrial Fibrillation Patients

Chendi Cui ¹ Laura Curry ¹ Nisha Singh ² Ning An Rosenthal ^1*

• ¹ Premier Inc, Charlotte, United States
• ² Bristol Myers Squibb, Dallas Fort Worth, United States

Background: Non-valvular atrial fibrillation (NVAF) significantly increases ischemic stroke and systemic embolism (SE) risks. Despite the proven efficacy of oral anticoagulants (OAC) in reducing these risks, their underutilization highlights a gap in clinical practice. This study examined OAC utilization patterns within the first year after NVAF diagnosis in patients without prior OAC use and the association between the timing of OAC initiation and the risk of all-cause and stroke/SE-specific hospitalizations.Methods: A retrospective cohort study was conducted using data from the PINC AI™ Healthcare Database and linked claims from 1/1/2017 to 3/31/2021. Patients newly diagnosed with NVAF, without prior OAC use, were included.Results: Of 23,148 adults with newly diagnosed NVAF, 11,059 (47.8%) initiated OAC within one year. OAC users predominantly had cardiovascular disease and risk factors, whereas non-OAC users had higher rates of malignancy and dementia. Early OAC initiation (74.9% during the index visit) was linked to lower hospitalization risks compared to those initiating later (29.2% vs. 45.9% for all-cause, p-value<0.001 and 1.3% vs. 2.6% for stroke/SE-specific, p-value<0.001). Adjusted odds ratios for all-cause and stroke/SE hospitalization favored early initiation were 0.35 (95%CI: 0.32 -0.39) and 0.34 (95%CI: 0.24 -0.47), respectively.This study highlights OAC underutilization in NVAF patients and suggests early initiation may lower hospitalization rates. The findings emphasize the need for further research into real-world compliance with OAC guidelines and call for further research to confirm the benefits of early initiation. Personalized management strategies that consider individual patient profiles are recommended.