AUTHOR=Cui Chendi , Curry Laura , Singh Nisha , Rosenthal Ning An 

TITLE=Oral anticoagulant timing and hospitalization in newly diagnosed nonvalvular atrial fibrillation patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1522154

DOI=10.3389/fcvm.2025.1522154

ISSN=2297-055X

ABSTRACT=BackgroundNon-valvular atrial fibrillation (NVAF) significantly increases ischemic stroke and systemic embolism (SE) risks. Despite the proven efficacy of oral anticoagulants (OAC) in reducing these risks, their underutilization highlights a gap in clinical practice. This study examined OAC utilization patterns within the first year after NVAF diagnosis in patients without prior OAC use and the association between the timing of OAC initiation and the risk of all-cause and stroke/SE-specific hospitalizations.MethodsA retrospective cohort study was conducted using data from the Premier Healthcare Database and linked claims from 1/1/2017–3/31/2021. Patients newly diagnosed with NVAF, without prior OAC use, were included.ResultsOf 23,148 adults with newly diagnosed NVAF, 11,059 (47.8%) initiated OAC within one year. OAC users predominantly had cardiovascular disease and risk factors, whereas non-OAC users had higher rates of malignancy and dementia. Early OAC initiation (74.9% during the index visit) was linked to lower hospitalization risks compared to those initiating later (29.2% vs. 45.9% for all-cause, p-value < 0.001 and 1.3% vs. 2.6% for stroke/SE-specific, p-value < 0.001). Adjusted odds ratios for all-cause and stroke/SE hospitalization favored early initiation were 0.35 (95% CI: 0.32–0.39) and 0.34 (95% CI: 0.24–0.47), respectively.ConclusionsThis study highlights OAC underutilization in NVAF patients and suggests early initiation may lower hospitalization rates. The findings emphasize the need for further research into real-world compliance with OAC guidelines and call for further research to confirm the benefits of early initiation. Personalized management strategies that consider individual patient profiles are recommended.