POSA417 Trends of Oral Anticoagulant Use and the Predictors of Initiation Choice between Men and Women with Atrial Fibrillation and Discharged from Hospital to the Community

To identify sex-specific factors associated with oral anticoagulant (OAC) initiation in patients with atrial fibrillation (AF). We built a cohort of AF patients hospitalized and discharged in the community from 2014 to 2017 using Quebec administrative hospitalization, medical and drug databases (Med-Echo and RAMQ). Cohort entry was defined as the first OAC claim for and being new users, defined as eligible patient without OAC treatment in the year prior to cohort entry. Warfarin and direct oral anticoagulants (DOAC) initiation choice among men and women was defined as the first prescription choice following hospital discharge in the community. Multivariate logistic regression was used to identify predictors of warfarin, low and high dose DOAC. A cohort of 21,289 patients were identified in which 54 % were women. In both sexes, warfarin initiation decreased and high dose apixaban initiation increased over the study period. The comorbidity burden was greater among warfarin users (with higher CHA2DS2-VASc score, Charlson-Deyo Comorbidity Index and Frailty score) than DOAC users. The predictors of warfarin initiation were similar in both sexes. In women, the predictors of low-dose DOAC initiation were age ≥80 (odds ratio: 10.77 (95% confidence interval [7.08-16.39]), a CHA2DS2-VASc score ≥3 (1.97 [1.41-2.76]), and a history of major bleeding (1.14 [1.03-1.26]). In men, the predictors of low-dose DOAC initiation were similar to its predictors in women, while also including coronary artery disease (1.21[1.07-1.37]), chronic kidney disease (1.84 [1.63 – 2.08]), and antiplatelet agent use (1.24 [1.10 – 1.41]). The predictors of high-dose DOAC initiation in men and women were cardiovascular disease risk factors. In both sexes, warfarin initiation decreased and high dose apixaban initiation increased over the study period. Several sex-specific predictors of OAC initiation were identified, showing few differences between sexes.