Caregiver assistance among Medicare beneficiaries with atrial fibrillation and factors associated with anticoagulant treatment

Chen SY, Vanderpoel J, Mody S, Nelson WW, Schein J, Rao P, Boulanger L.
Am J Geriatr Pharmacother. 2012 Oct;10(5):273-83. doi: 10.1016/j.amjopharm.2012.08.003. Epub 2012 Sep 12.

SOURCE:  United BioSource Corporation, Lexington, MA, USA.

BACKGROUND:  Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and disproportionately affects the elderly.

OBJECTIVE:  This study describes patient characteristics and caregiver assistance among Medicare beneficiaries with AF and examines factors associated with receiving anticoagulant treatment.

METHODS:  Patients with AF and age/gender-matched controls were identified from Medicare Current Beneficiary Survey data from 2001 to 2006. A logistic regression model was used to assess factors associated with receiving anticoagulants in a subgroup of patients with AF whose treatment pattern was established for 2 consecutive years. Sample weights were applied to obtain nationally representative estimates.

RESULTS:   A total of 2990 patients with AF and 5980 control patients were included in the burden of disease analysis, and 1481 patients with AF were included in the anticoagulant predictor analysis. Patients with AF had a higher level of comorbidity (Charlson Comorbidity Index: 3.3 vs 1.5; P < 0.05), worse self-perceived health status (P < 0.001), and greater level of disability (P < 0.001) than their matched counterparts. A greater proportion of patients with AF required caregiver assistance (62.8% vs 51.5%; P < 0.001). Logistic regression found that higher Charlson Comorbidity Index scores, difficulty in obtaining necessary health care, older age, being widowed, a history of psychiatric disorders, and being underweight decreased the likelihood of receiving anticoagulant therapy.

CONCLUSIONS:  In a Medicare population, a greater need for caregiver assistance was observed in patients with AF. Subgroups characterized by frailty or inability for self-care were identified as being less likely to receive anticoagulant therapy. The need for caregiver assistance among patients with AF, as well as the patient subgroups identified as less likely to receive anticoagulant therapy, should be considered when making treatment decisions.