DIRECT ORAL ANTICOAGULANT PRESCRIBING IN PATIENTS WITH ATRIAL FIBRILLATION AND CANCER ON HOSPICE ADMISSION
Author(s)
Phuong Y. Duong, PharmD1, Emily K. Short, BA, BS1, Jennifer Tjia, MD2, Matthew Alcusky, MS, PharmD, PhD2, Mary Lynn McPherson, PharmD, PhD3, Jon P. Furuno, PhD1;
1Oregon State University College of Pharmacy, Portland, OR, USA, 2UMass Chan Medical School, Worcester, MA, USA, 3University of Maryland School of Pharmacy, Baltimore, MD, USA
1Oregon State University College of Pharmacy, Portland, OR, USA, 2UMass Chan Medical School, Worcester, MA, USA, 3University of Maryland School of Pharmacy, Baltimore, MD, USA
OBJECTIVES: Cancer is prevalent at end-of-life and known to increase risks of stroke and bleeding. Although stroke and bleeding risk are differential by cancer type, it is unknown whether this influences anticoagulant prescribing decisions. We quantified differences in the odds of direct oral anticoagulant (DOAC) prescribing by cancer type among patients with atrial fibrillation (AF) on hospice admission.
METHODS: We analyzed electronic health record data from adults (age ≥18) with AF who died at a large, for-profit hospice chain between January 1, 2017 and December 31, 2019. We included patient demographics, Palliative Performance Scale, stroke (CHA₂DS₂-VASc) and bleeding (HAS-BLED) risk scores, and hospice care characteristics. Cancer types included lung, breast, colorectal, prostate, hematologic, skin, kidney, liver, gastric, bladder, pancreatic, bone, and head/neck. Analyses included multivariable logistic regression and results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
RESULTS: Among 13,233 hospice decedents, 53.6% were female, 65.1% were White, 94.0% were Hispanic, and mean (standard deviation (SD)) age was 84.2 (9.9) years. At hospice admission, 30.7% had cancer, most commonly lung (7.5%), liver (3.9%), breast (3.8%), prostate (3.7%), bone (3.5%), hematologic (3.4%), colorectal (2.9%), and skin (2.3%). Logistic regression results suggested that only pancreatic cancer was significantly associated with a DOAC prescription (aOR 2.02; 95% CI 1.2 - 3.3), after adjusting for patient demographics and hospice admission characteristics. Other cancer types associated with having a DOAC prescription but not statistically significant were lung (aOR 1.2; 95% CI 0.9 - 1.5) and breast (aOR 1.3; 95% CI 0.9 - 1.8).
CONCLUSIONS: Pancreatic cancer was significantly associated with higher odds of DOAC prescribing on hospice admission, whereas other cancer types were not. Future studies are needed to assess the appropriateness of anticoagulant use in hospice patients with cancer.
METHODS: We analyzed electronic health record data from adults (age ≥18) with AF who died at a large, for-profit hospice chain between January 1, 2017 and December 31, 2019. We included patient demographics, Palliative Performance Scale, stroke (CHA₂DS₂-VASc) and bleeding (HAS-BLED) risk scores, and hospice care characteristics. Cancer types included lung, breast, colorectal, prostate, hematologic, skin, kidney, liver, gastric, bladder, pancreatic, bone, and head/neck. Analyses included multivariable logistic regression and results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
RESULTS: Among 13,233 hospice decedents, 53.6% were female, 65.1% were White, 94.0% were Hispanic, and mean (standard deviation (SD)) age was 84.2 (9.9) years. At hospice admission, 30.7% had cancer, most commonly lung (7.5%), liver (3.9%), breast (3.8%), prostate (3.7%), bone (3.5%), hematologic (3.4%), colorectal (2.9%), and skin (2.3%). Logistic regression results suggested that only pancreatic cancer was significantly associated with a DOAC prescription (aOR 2.02; 95% CI 1.2 - 3.3), after adjusting for patient demographics and hospice admission characteristics. Other cancer types associated with having a DOAC prescription but not statistically significant were lung (aOR 1.2; 95% CI 0.9 - 1.5) and breast (aOR 1.3; 95% CI 0.9 - 1.8).
CONCLUSIONS: Pancreatic cancer was significantly associated with higher odds of DOAC prescribing on hospice admission, whereas other cancer types were not. Future studies are needed to assess the appropriateness of anticoagulant use in hospice patients with cancer.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD75
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Geriatrics, SDC: Oncology