Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States

Steven Deitelzweig; Christine L Baker; Amol D Dhamane; Jack Mardekian; Oluwaseyi Dina; Lisa Rosenblatt; Cristina Russ; Tayla Poretta; Melissa Lingohr-Smith; Jay Lin

doi:10.1080/21556660.2020.1750418

Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States

J Drug Assess. 2020 Apr 24;9(1):87-96. doi: 10.1080/21556660.2020.1750418. eCollection 2020.

Authors

Affiliations

¹ Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
² Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
³ Pfizer, Inc, New York, NY, USA.
⁴ Bristol-Myers Squibb, Lawrenceville, NJ, USA.
⁵ Novosys Health, Green Brook, NJ, USA.

Abstract

Objectives: To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods: Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013-30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. Results: NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02-1.08; p < .001), MB-related (OR: 1.28; CI: 1.16-1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11-1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02-1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44-1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion: In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.

Keywords: Atrial fibrillation; hospital readmissions; major bleeding; oral anticoagulants.