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Joint Latent Class Analysis of Oral Anticoagulation Use and Risk of Stroke or Systemic Thromboembolism in Patients with Atrial Fibrillation

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Nemin Chen & Maria M. Brooks

  2. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 3609 Forbes Avenue, Room 103, Pittsburgh, PA, 15261, USA

    Nico Gabriel & Inmaculada Hernandez

Authors
  1. Nemin Chen
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  2. Nico Gabriel
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  3. Maria M. Brooks
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  4. Inmaculada Hernandez
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Corresponding author

Correspondence to Inmaculada Hernandez.

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Funding

This study was funded by the National Institutes of Health (Grant Number UL1TR001857), and the National Heart, Lung and Blood Institute (Grant Number K01HL142847).

Conflict of interest

Inmaculada Hernandez has received consulting fees from Bristol Myers Squibb and Pfizer. Nemin Chen, Nico Gabriel, and Maria M. Brooks have no conflicts of interest to declare.

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Not applicable.

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Not applicable.

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Not applicable.

Availability of data and material

The authors are unable to share the data since the data were obtained under a data user agreement that does not allow data sharing.

Code availability

Code can be made available upon request to the corresponding author.

Author contributions

IH and NC designed the study; NG undertook the statistical analysis; NC wrote the manuscript; and IH, NG, and MMB undertook critical revision of the manuscript.

Supplementary Information

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Chen, N., Gabriel, N., Brooks, M.M. et al. Joint Latent Class Analysis of Oral Anticoagulation Use and Risk of Stroke or Systemic Thromboembolism in Patients with Atrial Fibrillation. Am J Cardiovasc Drugs 21, 573–580 (2021). https://doi.org/10.1007/s40256-021-00476-8

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