Background: As the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, have been introduced to the market for the indication of nonvalvular atrial fibrillation (NVAF) no studies have examined their impact on hospital readmissions. The objective of this study was to provide an early assessment of hospital readmissions among hospitalized NVAF patients treated with the 3 different NOACs in the US.
Methods: Patients (≥18 years) with a hospital discharge diagnosis of AF who received apixaban, dabigatran, or rivaroxaban during hospitalization were identified from the Premier Hospital database between 1/1/2012 and 2/28/2014. Patients were grouped into 3 cohorts depending on the NOAC received. Patient characteristics, hospital resource use, and costs associated with the initial hospitalizations and readmissions within 1 month were evaluated and compared among patients treated with the 3 NOACs at the unadjusted and regression adjusted levels.
Results: Among NVAF patients included in the study population, 4,138 were treated with apixaban, 37,754 were treated with rivaroxaban, and 32,838 were treated with dabigatran during hospitalization. Patients who received apixaban were older, had greater severity of comorbidity, and had higher stroke and bleeding risks (Table). At the unadjusted level, mean total hospital costs for readmission were $2,065, $2,345, and $2,078 for patients treated with apixaban, rivaroxaban, and dabigatran, respectively. After controlling for patient characteristics, including stroke and bleeding risks, in comparison with use of apixaban, the odds of all-cause and bleeding-related 1-month hospital readmissions for rivaroxaban were estimated at 1.2 (p<0.001) and 1.4 (p<0.01) respectively and for dabigatran at 1.1 (p=0.18) and 1.2 (p=0.13) respectively. In comparison with use of apixaban, the use of rivaroxaban and dabigatran were associated with longer average hospital length of stay (0.25 days, p<0.001; 0.11, p=0.08 respectively) and higher hospital cost per patient ($418, p<0.01; $156, p=0.27 respectively) due to the 1-month readmissions.
Conclusion: In this early assessment, treatment with rivaroxaban vs. apixaban was associated with greater risk of all-cause or bleeding-related 1-month readmissions and higher hospital costs due to readmissions.