Background

Oral anticoagulation (OAC) is recommended to reduce the risk of stroke or systemic thromboembolism (TE) in atrial fibrillation (AF). In this study, we applied novel joint latent class mixed models to identify heterogeneous patterns of trajectories of OAC use and determined how these trajectories are associated with risks of thromboembolic outcomes.

Methods and Results

We used 2013–2016 claims data from a 5% random sample of Medicare beneficiaries, obtained from the Centers for Medicare and Medicaid Services. Our study sample included 16,399 patients newly diagnosed with AF in 2014–2015 who were followed for 12 months after the first AF diagnosis and filled at least one OAC prescription in this time period. OAC use was defined as the number of days covered with OACs every 30-day interval after the first AF diagnosis. We used a joint latent class mixed model to simultaneously evaluate the longitudinal patterns of OAC use and time to stroke or TE, while adjusting for age, race, CHAD2S2-VASc score and HAS-BLED score.

Five classes of OAC use patterns were identified: late users (17.8%); late initiators (12.5%); early discontinuers (18.6%); late discontinuers (15.4%); and continuous users (35.6%). Compared with continuous users, the risk of stroke or TE was higher for participants in the late initiators (hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.49–2.01) and late discontinuers (HR 1.23, 95% CI 1.04–1.45) classes.

Conclusion

Late initiators and late discontinuers had a higher risk of stroke or TE than continuous users. Early initiation and continuous OAC use is important in preventing stroke and TE among patients diagnosed with AF.

中文翻译：

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房颤患者口服抗凝药物使用与卒中或全身性血栓栓塞风险的联合潜在类别分析

背景

建议口服抗凝剂 (OAC) 以降低房颤 (AF) 患者中风或全身血栓栓塞 (TE) 的风险。在这项研究中，我们应用了新的联合潜在类别混合模型来识别 OAC 使用轨迹的异质模式，并确定这些轨迹如何与血栓栓塞结果的风险相关。

方法和结果

我们使用了从医疗保险和医疗补助服务中心获得的 5% 的医疗保险受益人随机样本中的 2013-2016 年索赔数据。我们的研究样本包括 2014-2015 年新诊断为 AF 的 16,399 名患者，这些患者在首次 AF 诊断后随访 12 个月，并在此期间至少填写了一份 OAC 处方。OAC 的使用定义为首次 AF 诊断后每 30 天间隔使用 OAC 的天数。我们使用联合潜在类别混合模型同时评估 OAC 使用的纵向模式和中风或 TE 时间，同时调整年龄、种族、CHAD2S2-VASc 评分和 HAS-BLED 评分。

确定了五类 OAC 使用模式：迟到的用户（17.8%）；晚期引发剂（12.5%）；早期中断者（18.6%）；迟到者（15.4%）；和持续用户（35.6%）。与持续使用者相比，晚期起始者（风险比 [HR] 1.73，95% 置信区间 [CI] 1.49-2.01）和晚期终止者（HR 1.23，95% CI 1.04-）的参与者发生中风或 TE 的风险更高1.45) 类。

结论

与持续使用者相比，晚期开始者和晚期停止者患中风或 TE 的风险更高。早期开始和持续使用 OAC 对预防诊断为 AF 的患者中风和 TE 很重要。