Background: Little is known about whether insurance status affects the presentation and treatment of patients with atrial fibrillation (AF).
Methods: We used data from the ORBIT-AF Registry (2010 - 2011), a national, large outpatient registry, to evaluate clinical characteristics and oral anticoagulation (OAC) use. We examined differences in comorbidities and receipt of OAC among patients enrolled in the Medicaid program at baseline compared with those not enrolled in Medicaid. After restricting to patients who were taking OAC, we compared receipt of novel oral anticoagulants (dabigatran or rivaroxaban) versus warfarin by Medicaid status during 2 years of followup. We used logistic regression models adjusting for demographic and clinical covariates to evaluate baseline OAC receipt by Medicaid status.
Results: Of 10,133 patients, N=470 (4.6%) were classified as having Medicaid insurance. Compared with those with other insurance, Medicaid patients were younger (70.0 years; IQR=61.0 - 79.0 vs. 75.0 years; IQR=67.0 - 82.0), more likely to be female (53.0% vs. 41.8%), and less likely to be white (58.7% vs. 90.7%; all p<0.001). Medicaid patients had higher rates of smoking, prior stroke/TIA, diabetes, hypertension, and HF. Medicaid patients were less likely to be taking OAC at baseline, a difference that was particularly pronounced for high stroke risk patients (CHADS2>=2, p<0.001; Table). Among those on anticoagulation, Medicaid patients were less likely to receive NOAC over 2 years of followup. In adjusted analyses, Medicaid patients were less likely to receive OAC at baseline, but this difference was not statistically significant (HR = 0.82; 95% CI = 0.61, 1.09). Among untreated patients with CHADS2>=2, Medicaid patients were more likely than patients with other insurance to have “unable to adhere/monitor” listed as a contraindication to OAC (p<0.001).
Conclusions: In a contemporary, community-based AF cohort, Medicaid patients had a greater comorbidity burden and higher stroke risk, yet were less likely to receive OAC compared with those with other forms of insurance.