Factors Correlated with Anticoagulation Choice in Primary Care Patients with Atrial Fibrillation and High Stroke Risk: Anticoagulation for NVAF in Primary Care

Background: The available data on anticoagulation therapy in real-world primary care settings for atrial fibrillation (AF) patients at high risk of stroke is limited. Objective: To evaluate anticoagulation therapy and elucidate the factors associated with the selection between direct oral anticoagulants (DOACs) and warfarin. Design and Participants: This is a retrospective cohort study that included patients >= 18 years old at a large primary care outpatient group, a network of twenty clinics in the northeast United States between January 4, 2021 - January 4, 2023. Main Measures: Oral anticoagulation therapy in AF patients with high risk of stroke (CHA(2)DS(2)-VASc score of >= 2 in men or >= 3 in women). Key Results: Among the 3,118 adult patients with AF and high risk of stroke (median age 77.90, IQR 71.66-84.50 years; male 57.6%), we found that older age (aOR 1.40, p=0.003), greater BMI (25-29.9: aOR 1.32, p=0.048;>= 30 aOR 1.42, p=0.010), and taking more than five medications (aOR 2.28, p<0.001) were more likely to be on an oral anticoagulant. Among those taking an OAC, having Medicare as the sole coverage (aOR 0.53, p=0.032), male gender (aOR 0.69, p=0.011), worse renal function (aOR 0.80, p=0.021), and higher CHA(2)DS(2)-VASc score (aOR 0.88, p=0.024) are more likely to be on warfarin than a DOAC. Patients taking more than five medications daily (6-10 medications: aOR 1.92, p=0.013;>= 16: aOR=2.10, p=0.006) were more likely to be on an anticoagulant and may receive a DOAC over warfarin. Conclusions: AF with high stroke risk adult patients are more likely to be on an oral anticoagulant if they are older, having BMI >= 25, or taking more than five medications. Medicare as the sole coverage, male gender, worse renal function, and higher CHA(2)DS(2)-VASc scores are factors associated with greater warfarin usage, while patients taking over five daily medications are more likely to be prescribed DOACs.