Table 2.
Factors Associated With OAC Initiation, Adherence, and Discontinuation
| Initiation | Adherence | Discontinuation | ||||
|---|---|---|---|---|---|---|
| OR (95% CI) | P value | OR (95% CI) | P value | sHR (95% CI) | P value | |
| Postoperative AF | 0.64 (0.63–0.65) | <0.0001 | 0.66 (0.64– 0.67) | <0.0001 | 1.23 (1.21–1.24) | <0.0001 |
| Age | ||||||
| 18–64 y | Ref | Ref | Ref | Ref | Ref | Ref |
| 65–74 y | 1.13 (1.10–1.15) | <0.0001 | 1.17 (1.12–1.21) | <0.0001 | 0.76 (0.75–0.78) | <0.0001 |
| 75+ y | 1.14 (1.11–1.16) | <0.0001 | 1.30 (1.25–1.35) | <0.0001 | 0.78 (0.76–0.79) | <0.0001 |
| Female | 0.99 (0.97–1.00) | 0.0720 | 1.22 (1.19–1.25) | <0.0001 | 0.87 (0.86–0.88) | <0.0001 |
| Race or ethnicity | ||||||
| White | Ref | Ref | Ref | Ref | Ref | Ref |
| Asian | 0.78 (0.74–0.81) | <0.0001 | 0.84 (0.78–0.92) | 0.0001 | 1.06 (1.01–1.10) | 0.0180 |
| Black | 0.86 (0.84–0.87) | <0.0001 | 0.79 (0.76–0.82) | <0.0001 | 1.14 (1.12–1.16) | <0.0001 |
| Hispanic/Latino | 0.82 (0.80–0.85) | <0.0001 | 0.75 (0.71–0.78) | <0.0001 | 1.16 (1.13–1.19) | <0.0001 |
| Other/Unknown* | 0.91 (0.87–0.95) | <0.0001 | 0.91 (0.85–0.98) | 0.0151 | 1.08 (1.04–1.12) | 0.0001 |
| Year of AF diagnosis | ||||||
| 2012 | Ref | Ref | Ref | Ref | Ref | Ref |
| 2013 | 1.02 (0.98–1.06) | 0.2593 | 1.07 (1.00–1.15) | 0.0465 | 0.96 (0.93–0.99) | 0.0076 |
| 2014 | 1.07 (1.03–1.11) | 0.0007 | 1.12 (1.04–1.20) | 0.0014 | 0.91 (0.88–0.95) | <0.0001 |
| 2015 | 1.07 (1.03–1.11) | 0.0002 | 1.32 (1.24–1.41) | <0.0001 | 0.80 (0.77–0.82) | <0.0001 |
| 2016 | 1.23 (1.18–1.27) | <0.0001 | 1.41 (1.32–1.50) | <0.0001 | 0.76 (0.73–0.78) | <0.0001 |
| 2017 | 1.26 (1.22–1.30) | <0.0001 | 1.56 (1.47–1.65) | <0.0001 | 0.73 (0.71–0.75) | <0.0001 |
| 2018 | 1.61 (1.55–1.66) | <0.0001 | 1.51 (1.43–1.60) | <0.0001 | 0.74 (0.72–0.76) | <0.0001 |
| 2019 | 1.77 (1.71–1.83) | <0.0001 | 1.68 (1.58–1.77) | <0.0001 | 0.72 (0.70–0.74) | <0.0001 |
| 2020 | 2.14 (2.07–2.22) | <0.0001 | 1.68 (1.58–1.78) | <0.0001 | 0.75 (0.73–0.77) | <0.0001 |
| 2021 | 2.44 (2.36–2.52) | <0.0001 | 1.65 (1.56–1.75) | <0.0001 | 0.81 (0.79–0.84) | <0.0001 |
| Medical history | ||||||
| Heart failure | 0.97 (0.95–0.98) | 0.0001 | 0.93 (0.90–0.96) | <0.0001 | 1.10 (1.08–1.12) | <0.0001 |
| Hypertension | 1.14 (1.11–1.18) | <0.0001 | 1.14 (1.09–1.19) | <0.0001 | 0.81 (0.80–0.83) | <0.0001 |
| Diabetes | 1.06 (1.04–1.07) | <0.0001 | 0.98 (0.95–1.00) | 0.0719 | 0.99 (0.98–1.01) | 0.4162 |
| Thromboembolism | 1.08 (1.06–1.10) | <0.0001 | 1.07 (1.04–1.10) | <0.0001 | 0.97 (0.95–0.98) | <0.0001 |
| Other supraventricular arrhythmia | 0.73 (0.71–0.75) | <0.0001 | 1.06 (1.01–1.12) | 0.0193 | 0.99 (0.97–1.02) | 0.4785 |
| Ventricular arrhythmia | 0.82 (0.79–0.84) | <0.0001 | 1.02 (0.97–1.08) | 0.4492 | 0.97 (0.94–1.00) | 0.0281 |
| CAD | 0.80 (0.79–0.81) | <0.0001 | 0.86 (0.84–0.88) | <0.0001 | 1.07 (1.06–1.09) | <0.0001 |
| PAD | 0.96 (0.94–0.98) | 0.0001 | 0.95 (0.92–0.99) | 0.0079 | 1.08 (1.06–1.10) | <0.0001 |
| Major bleeding | 0.96 (0.93–0.99) | 0.0167 | 1.07 (1.01–1.12) | 0.0198 | 1.00 (0.97–1.03) | 0.9786 |
| Stage 3–5 CKD | 0.99 (0.98–1.01) | 0.5109 | 0.98 (0.95–1.01) | 0.2046 | 1.06 (1.05–1.08) | <0.0001 |
| Liver disease | 0.93 (0.91–0.96) | <0.0001 | 0.96 (0.92–1.00) | 0.0527 | 1.03 (1.01–1.06) | 0.0016 |
| Non–skin cancer | 0.96 (0.94–0.98) | <0.0001 | 0.98 (0.95–1.01) | 0.1023 | 1.05 (1.04–1.07) | <0.0001 |
| Fall | 0.89 (0.88–0.91) | <0.0001 | 0.92 (0.90–0.95) | <0.0001 | 1.12 (1.10–1.13) | <0.0001 |
| Anemia | 0.88 (0.87–0.90) | <0.0001 | 0.92 (0.89–0.94) | <0.0001 | 1.08 (1.07–1.10) | <0.0001 |
| Alcoholism | 0.86 (0.83–0.89) | <0.0001 | 0.80 (0.76–0.85) | <0.0001 | 1.12 (1.09–1.16) | <0.0001 |
| Concomitant use of antiplatelet | 0.78 (0.77–0.80) | <0.0001 | 1.14 (1.09–1.18) | <0.0001 | 0.92 (0.90–0.94) | <0.0001 |
| Contraindications of OAC use | ||||||
| Intracranial bleeding | 0.85 (0.80–0.89) | <0.0001 | 0.97 (0.88–1.06) | 0.4948 | 0.99 (0.94–1.04) | 0.5962 |
| Recent bleed event | 0.56 (0.53–0.59) | <0.0001 | 0.85 (0.75–0.95) | 0.0048 | 1.15 (1.08–1.22) | <0.0001 |
| Cerebral amyloid angiopathy | 0.35 (0.23–0.55) | <0.0001 | 1.40 (0.55–3.56) | 0.4839 | 1.28 (0.88–1.86) | 0.1970 |
| Cerebral aneurysm | 0.91 (0.84–0.99) | 0.0267 | 1.01 (0.87–1.17) | 0.8768 | 1.08 (1.01–1.16) | 0.0286 |
| Pericarditis/pericardial effusions | 0.79 (0.66–0.94) | 0.0075 | 0.88 (0.64–1.21) | 0.4236 | 1.18 (1.00–1.40) | 0.0509 |
| Renal failure requiring dialysis | 0.83 (0.78–0.88) | <0.0001 | 0.75 (0.67–,0.84) | <0.0001 | 1.27 (1.20–1.34) | <0.0001 |
| Coagulation defects | 1.78 (1.72–1.85) | <0.0001 | 1.24 (1.17–1.31) | <0.0001 | 0.82 (0.79–0.84) | <0.0001 |
| End‐stage liver disease | 0.99 (0.96–1.03) | 0.6925 | 1.00 (0.94–1.07) | 0.9481 | 1.01 (0.97–1.04) | 0.6897 |
| Gastrointestinal cancer | 0.98 (0.95–1.01) | 0.1620 | 0.95 (0.91–1.01) | 0.0845 | 1.02 (0.99–1.05) | 0.1831 |
| Other gastrointestinal contraindications | 0.97 (0.94–1.00) | 0.0506 | 0.89 (0.84–0.94) | 0.0001 | 1.03 (1.00–1.06) | 0.0790 |
| Provider specialty | ||||||
| Surgery and others | Ref | Ref | Ref | Ref | Ref | Ref |
| Cardiology | 2.92 (2.87–2.98) | <0.0001 | 1.08 (1.04–1.13) | <0.0001 | 0.83 (0.82–0.85) | <0.0001 |
| Primary care | 1.29 (1.27–1.32) | <0.0001 | 0.98 (0.94–1.03) | 0.4692 | 0.90 (0.88–0.92) | <0.0001 |
AF indicates atrial fibrillation; CAD, coronary artery disease; CKD, chronic kidney disease; OAC, oral anticoagulant; OR, odds ratio; PAD, peripheral artery disease;and sHR, subdistribution hazard ratio; OR and 95% CI were obtained from multivariable logistic regression models. sHR and 95% CI were obtained from multivariable time‐to‐event analyses considering mortality as the competing risk using the Fine and Gray method.
*
Other/unknown includes patients who identified themselves outside any of the prior categories or such information was not available.