Arrhythmias & electrophysiology
Medicare coverage gap status, adherence to oral anticoagulation, and stroke rates in patients with atrial fibrillation
Authors' conclusion
OAC use decreased upon entering the coverage gap and was associated with an increased stroke risk, that persisted for the rest of the calendar year. Health policy decisions regarding Medicare can have unintended adverse public health consequences, highlighting the importance of assessing the impact of such policy changes.
Study context
- Population
- Medicare Part D beneficiaries with atrial fibrillation (AF), Centers for Medicare and Medicaid Services claims data 2016 to 2018
- Comparison
- Oral anticoagulant (OAC) proportion of days covered and hazard of stroke before, during, and after the coverage gap
- Outcome
- Median proportion of days covered on OAC, patients who entered the coverage gap
Main finding
As reported in the abstract
Pregap
0.92
median · IQR 0.80–0.97
In-gap
0.76
median · IQR 0.41–0.98
- Decrease in median proportion of days covered from pregap to in-gap
- 16%
Further findings
| Outcome | Pregap | In-gap | Postgap |
|---|---|---|---|
| Proportion of days covered, patients who entered and then left the coverage gapContinued to drop despite regaining coverage | 0.95 (IQR 0.85–0.98) | 0.88 (IQR 0.55–0.97) | 0.70 (IQR 0.00–1.00) |
Stroke risk, patients who entered the gap
- While in the gap, HR
- 2.21, 95% CI 1.91-2.54
- Combined in-gap and postgap periods, HR
- 3.13, 95% CI 2.71-3.62
- Comparator period not stated in the abstract
Original publication
Medicare coverage gap status, adherence to oral anticoagulation, and stroke rates in patients with atrial fibrillation. Am Heart J. Published 6 August 2025. doi:10.
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