title: Caregiver assistance among Medicare beneficiaries with atrial fibrillation and factors associated with anticoagulant treatment.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and disproportionately affects the elderly.
  
  
  OBJECTIVE
  This study describes patient characteristics and caregiver assistance among Medicare beneficiaries with AF and examines factors associated with receiving anticoagulant treatment.
  
  
  METHODS
  Patients with AF and age/gender-matched controls were identified from Medicare Current Beneficiary Survey data from 2001 to 2006. A logistic regression model was used to assess factors associated with receiving anticoagulants in a subgroup of patients with AF whose treatment pattern was established for 2 consecutive years. Sample weights were applied to obtain nationally representative estimates.
  
  
  RESULTS
  A total of 2990 patients with AF and 5980 control patients were included in the burden of disease analysis, and 1481 patients with AF were included in the anticoagulant predictor analysis. Patients with AF had a higher level of comorbidity (Charlson Comorbidity Index: 3.3 vs 1.5; P < 0.05), worse self-perceived health status (P < 0.001), and greater level of disability (P < 0.001) than their matched counterparts. A greater proportion of patients with AF required caregiver assistance (62.8% vs 51.5%; P < 0.001). Logistic regression found that higher Charlson Comorbidity Index scores, difficulty in obtaining necessary health care, older age, being widowed, a history of psychiatric disorders, and being underweight decreased the likelihood of receiving anticoagulant therapy.
  
  
  CONCLUSIONS
  In a Medicare population, a greater need for caregiver assistance was observed in patients with AF. Subgroups characterized by frailty or inability for self-care were identified as being less likely to receive anticoagulant therapy. The need for caregiver assistance among patients with AF, as well as the patient subgroups identified as less likely to receive anticoagulant therapy, should be considered when making treatment decisions.
authors.affiliation: United BioSource Corporation, Lexington, MA, USA.
authors.forename: Shih-Yin
authors.initials: SY
authors.lastname: Chen
authors.forename: Julie
authors.initials: J
authors.lastname: Vanderpoel
authors.forename: Samir
authors.initials: S
authors.lastname: Mody
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Nelson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schein
authors.forename: Preethi
authors.initials: P
authors.lastname: Rao
authors.forename: Luke
authors.initials: L
authors.lastname: Boulanger
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D017028:Caregivers / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data; D014481:United States
chemical_list: D000925:Anticoagulants