Prospective Monitoring of Non-Vitamin K Oral Anticoagulants in Older Adults With Atrial Fibrillation and Frailty

NCT ID: NCT04878497

Last Updated: 2021-05-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

1000000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-03-30

Study Completion Date

2022-12-31

Brief Summary

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The objective of this study is to establish a near-real-time prospective monitoring program in Medicare, Optum and MarketScan Research data to evaluate the benefit of new cardiovascular disease (CVD) drugs for older adults with frailty. Prospective monitoring program seeks to find early effectiveness and safety signals of new drugs by updating the analysis at regular intervals as new Medicare data become available. This study specifically aims to emulate a prospective surveillance of the effectiveness and safety of non-vitamin K oral anticoagulants (NOAC) vs. a comparator, warfarin, in older adults with atrial fibrillation and different frailty status. This program will be enhanced by incorporating a novel claims-based frailty index, which has been shown useful in assessing how the benefits and harms of drug therapy vary by frailty.

Detailed Description

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Data sources of use for this study are: Medicare Database, Optum Database, and MarketScan Research Database. All data from years 2013-2020 (available data may vary depending on the database) will be analyzed in the study.

This study follows a sequential cohort monitoring design. The monitoring analysis will include 1) retrospective analysis of available data (2013-2018) at the time of first analysis (April 2021) and 2) prospective analysis of new data (2019-2020) as they become available to the researchers. Within each database and by frailty status (frail vs non-frail), the investigators will emulate annual updating of data by creating a propensity score (PS)-matched cohort of new users every 1-year interval. Each sequential cohort will be followed for development of the outcomes of interest. At the end of each interval, time-to-event data from all sequential cohorts will be pooled for outcome analysis. The surveillance will be performed by frailty status (frail vs non-frail) at the time of drug initiation.

Conditions

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Atrial Fibrillation Frailty Anticoagulant-induced Bleeding Stroke

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Warfarin

New users of warfarin

Warfarin

Intervention Type DRUG

Initiation of warfarin, identified using prescription fill in pharmacy claims

Dabigatran

New users of dabigatran

Dabigatran

Intervention Type DRUG

Initiation of dabigatran, identified using prescription fill in pharmacy claims

Rivaroxaban

New users of rivaroxaban

Rivaroxaban

Intervention Type DRUG

Initiation of rivaroxaban, identified using prescription fill in pharmacy claims

Apixaban

New users of apixaban

Apixaban

Intervention Type DRUG

Initiation of apixaban, identified using prescription fill in pharmacy claims

Edoxaban

New users of edoxaban

Edoxaban

Intervention Type DRUG

Initiation of edoxaban, identified using prescription fill in pharmacy claims

Interventions

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Warfarin

Initiation of warfarin, identified using prescription fill in pharmacy claims

Intervention Type DRUG

Dabigatran

Initiation of dabigatran, identified using prescription fill in pharmacy claims

Intervention Type DRUG

Rivaroxaban

Initiation of rivaroxaban, identified using prescription fill in pharmacy claims

Intervention Type DRUG

Apixaban

Initiation of apixaban, identified using prescription fill in pharmacy claims

Intervention Type DRUG

Edoxaban

Initiation of edoxaban, identified using prescription fill in pharmacy claims

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Initiation of a NOAC or warfarin (day 0 is the initiation day)
* Continuous enrollment in medical and drug insurance in \[-183, 0\] days
* Diagnosis of AF in \[-183, 0\] days
* CHA2DS2-VASc score ≥2 (moderate or high risk for stroke)
* No prior use of NOAC or warfarin in \[-183, -1\] days
* No recent hospitalization for stroke or major bleeding in \[-60, 0\] days
* No recent nursing facility stay in \[-60, 0\] days

Exclusion Criteria

* Contraindication to either drug in \[-183, 0\] days
* Valvular heart disease or mechanical heart valve in \[-183, 0\] days
* Intracranial or retroperitoneal hemorrhage in \[-183, 0\] days
* Chronic kidney disease stage V, end-stage renal disease, or dialysis in \[-183, 0\] days
* Other indications for anticoagulation therapy in \[-183, 0\] days
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Brigham and Women's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Dae Hyun Kim, MD, MPH, ScD

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dae Hyun Kim, MD, MPH, ScD

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Locations

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Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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2019P000110-NOAC

Identifier Type: -

Identifier Source: org_study_id

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