# Demographic and Socio-Economic Disparities in the Outcomes Among Patients with NVAF Treated with Oral Anticoagulants: A Real-World Evaluation of Medicare Beneficiaries

## TL;DR

This study finds that apixaban is more effective and safer than other blood thinners for treating heart rhythm issues in Medicare patients, especially those with low income.

## Contribution

The study provides real-world evidence of apixaban's benefits across diverse socio-economic and demographic groups.

## Key findings

- Apixaban reduced stroke and bleeding risks compared to warfarin, rivaroxaban, and dabigatran.
- Benefits of apixaban were consistent across low, medium, and other socio-economic groups.
- Apixaban showed lower risks in most demographic and socio-economic subgroups.

## Abstract

Objectives: To assess the association between apixaban use and the risk of stroke/systemic embolism (SE) and major bleeding (MB) compared with other anticoagulants (OACs) across demographic and socio-economic subgroups in the treatment of nonvalvular atrial fibrillation (NVAF). Methods: The study included adult NVAF patients initiating OAC treatment between 2013 and 2019 in the Medicare database. Inverse probability treatment weighted Cox proportional hazard models were used to assess stroke/SE and MB outcomes across various subgroups. Results: Overall, the adjusted risks of stroke/SE and MB were lower for apixaban compared with warfarin (stroke/SE: HR, 0.69, [95% confidence interval (CI): 0.65–0.74], MB: 0.59 [95% CI: 0.57–0.60]), rivaroxaban (stroke/SE: 0.88 [95% CI: 0.84–0.92], MB: 0.60 [95% CI: 0.58–0.61]) and dabigatran (stroke/SE: 0.88 [95% CI: 0.80–0.95], MB: 0.76 [95% CI: 0.72–0.80]). Among the low socio-economic status (SES) group, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.73 [95% CI: 0.69–0.77], MB: 0.60 [95% CI: 0.57–0.62]) and rivaroxaban (stroke/SE: 0.88 [95% CI: 0.83–0.94], MB: 0.61 [95% CI: 0.59–0.63]). Among medium SES patients, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.67 [95% CI: 0.63–0.71] MB: 0.60 [95% CI: 0.58–0.63]), rivaroxaban (stroke/SE: 0.85 [95% CI: 0.79–0.91], MB: 0.59 [95% CI: 0.56–0.61]) and dabigatran (stroke/SE: 0.85 [95% CI: 0.73–0.99], MB: 0.77 [95% CI: 0.70–0.84]). Apixaban was also associated with lower risks of stroke/SE and MB compared with other OACs among most other demographic, socio-economic subgroups. Conclusions: Apixaban was associated with lower risk of stroke/SE and MB than warfarin, rivaroxaban, dabigatran across most demographic, socio-economic subgroups.