{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:38:54Z","timestamp":1778067534143,"version":"3.51.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Janssen Scientific Affairs, LLC, a Johnson & Johnson Company"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Interv Card Electrophysiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are often comorbid and associated with increased risk of cardiovascular events such as stroke. We evaluated the effectiveness, safety, healthcare resource utilization, and costs of rivaroxaban versus warfarin in patients with nonvalvular AF (NVAF) and comorbid OSA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We used the IQVIA PharMetrics<jats:sup>\u00ae<\/jats:sup> Plus adjudicated claims database to evaluate patients with NVAF, OSA, and moderate-to-severe stroke risk who initiated rivaroxaban or warfarin between November 2011 and December 2022. We adjusted for potential confounders with propensity score overlap weighting. Primary endpoints were evaluated based on intent-to-treat (ITT) and on-treatment follow-up to compare stroke or systemic embolism risk, major bleeding risk, all-cause healthcare resource utilization (inpatient hospitalizations, emergency department visits, outpatient visits, and pharmacy fills), and costs (per patient per year [PPPY]) by treatment cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In total, 14,765 patients were included (9133 received rivaroxaban; 5632 received warfarin). Rivaroxaban significantly reduced stroke or systemic embolism versus warfarin by 26% (ITT\u2014hazard ratio, 0.74 [95% CI 0.60\u20130.91]; <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and 30% (on-treatment\u2014hazard ratio, 0.70 [95% CI 0.55\u20130.89]; <jats:italic>P<\/jats:italic>\u2009=\u20090.004). Major bleeding was not significantly different between rivaroxaban and warfarin in either analysis. All-cause healthcare resource utilization was significantly reduced with rivaroxaban versus warfarin, leading to significantly reduced PPPY costs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Among patients with NVAF and OSA, rivaroxaban was associated with a significant reduction in stroke or systemic embolism risk versus warfarin with no difference in major bleeding. Rivaroxaban significantly reduced healthcare resource utilization and costs compared with warfarin, providing support for the use of rivaroxaban in this population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10840-024-01940-6","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T13:48:32Z","timestamp":1732542512000},"page":"613-624","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and economic outcomes with rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and obstructive sleep apnea: retrospective analysis of US healthcare claims"],"prefix":"10.1007","volume":"68","author":[{"given":"Andrea","family":"Natale","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanghamitra","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia K.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brahim","family":"Bookhart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-1897","authenticated-orcid":false,"given":"Veronica","family":"Ashton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"issue":"1","key":"1940_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","volume":"127","author":"J Kornej","year":"2020","unstructured":"Kornej J, Borschel CS, Benjamin EJ, et al. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127(1):4\u201320. https:\/\/doi.org\/10.1161\/CIRCRESAHA.120.316340.","journal-title":"Circ Res"},{"issue":"1","key":"1940_CR2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1093\/europace\/euac062","volume":"25","author":"RB Schnabel","year":"2023","unstructured":"Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET\/EHRA consensus conference. Europace. 2023;25(1):6\u201327. https:\/\/doi.org\/10.1093\/europace\/euac062.","journal-title":"Europace"},{"key":"1940_CR3","doi-asserted-by":"publisher","first-page":"e125","DOI":"10.1161\/CIR.0000000000000665","volume":"140","author":"CT January","year":"2019","unstructured":"January CT, Wann LS, Calkins H, et al. 2019 AHA\/ACC\/HRS focused update of the 2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140:e125\u201351. https:\/\/doi.org\/10.1161\/CIR.0000000000000665.","journal-title":"Circulation"},{"key":"1940_CR4","doi-asserted-by":"publisher","first-page":"668","DOI":"10.3389\/fneur.2017.00668","volume":"8","author":"E Marulanda-Londono","year":"2017","unstructured":"Marulanda-Londono E, Chaturvedi S. The interplay between obstructive sleep apnea and atrial fibrillation. Front Neurol. 2017;8:668. https:\/\/doi.org\/10.3389\/fneur.2017.00668.","journal-title":"Front Neurol"},{"issue":"6","key":"1940_CR5","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1001\/jamacardio.2018.0095","volume":"3","author":"D Linz","year":"2018","unstructured":"Linz D, McEvoy RD, Cowie MR, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. 2018;3(6):532\u201340. https:\/\/doi.org\/10.1001\/jamacardio.2018.0095.","journal-title":"JAMA Cardiol"},{"issue":"14","key":"1940_CR6","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1001\/jama.2020.3514","volume":"323","author":"DJ Gottlieb","year":"2020","unstructured":"Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323(14):1389\u2013400. https:\/\/doi.org\/10.1001\/jama.2020.3514.","journal-title":"JAMA"},{"key":"1940_CR7","doi-asserted-by":"publisher","unstructured":"Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023. https:\/\/doi.org\/10.1161\/CIR.0000000000001193","DOI":"10.1161\/CIR.0000000000001193"},{"key":"1940_CR8","unstructured":"Gelburd R. Sleep apnea: a growing public health issue. AJMC. https:\/\/www.ajmc.com\/view\/sleep-apnea-a-growing-public-health-issue, 2018 (accessed 1 July 2024)."},{"issue":"6","key":"1940_CR9","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1161\/01.HYP.0000101686.98973.A3","volume":"42","author":"R Wolk","year":"2003","unstructured":"Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003;42(6):1067\u201374. https:\/\/doi.org\/10.1161\/01.HYP.0000101686.98973.A3.","journal-title":"Hypertension"},{"issue":"14","key":"1940_CR10","doi-asserted-by":"publisher","first-page":"3099","DOI":"10.3390\/jcm10143099","volume":"10","author":"C Zolotoff","year":"2021","unstructured":"Zolotoff C, Bertoletti L, Gozal D, et al. Obstructive sleep apnea, hypercoagulability, and the blood-brain barrier. J Clin Med. 2021;10(14):3099. https:\/\/doi.org\/10.3390\/jcm10143099.","journal-title":"J Clin Med"},{"issue":"6","key":"1940_CR11","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1002\/joa3.12784","volume":"38","author":"YK Iwasaki","year":"2022","unstructured":"Iwasaki YK. Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea. J Arrhythm. 2022;38(6):974\u201380. https:\/\/doi.org\/10.1002\/joa3.12784.","journal-title":"J Arrhythm"},{"issue":"5","key":"1940_CR12","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.ahj.2014.12.024","volume":"169","author":"F Holmqvist","year":"2015","unstructured":"Holmqvist F, Guan N, Zhu Z, et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation\u2014results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2015;169(5):647-54.e2. https:\/\/doi.org\/10.1016\/j.ahj.2014.12.024.","journal-title":"Am Heart J"},{"issue":"5","key":"1940_CR13","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/clc.22933","volume":"41","author":"AM Abumuamar","year":"2018","unstructured":"Abumuamar AM, Dorian P, Newman D, et al. The prevalence of obstructive sleep apnea in patients with atrial fibrillation. Clin Cardiol. 2018;41(5):601\u20137. https:\/\/doi.org\/10.1002\/clc.22933.","journal-title":"Clin Cardiol"},{"key":"1940_CR14","unstructured":"Heart Rhythm Society. Atrial fibrillation and sleep apnea: what you need to know. 2015. https:\/\/www.hrsonline.org\/documents\/atrial-fibrillation-and-sleep-apnea\/download (accessed 1 July 2024)."},{"issue":"3","key":"1940_CR15","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.jphs.2018.07.002","volume":"137","author":"H Imano","year":"2018","unstructured":"Imano H, Kato R, Tanikawa S, et al. Factor Xa inhibition by rivaroxaban attenuates cardiac remodeling due to intermittent hypoxia. J Pharmacol Sci. 2018;137(3):274\u201382. https:\/\/doi.org\/10.1016\/j.jphs.2018.07.002.","journal-title":"J Pharmacol Sci"},{"issue":"6","key":"1940_CR16","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1002\/pds.2109","volume":"20","author":"A Cunningham","year":"2011","unstructured":"Cunningham A, Stein CM, Chung CP, et al. An automated database case definition for serious bleeding related to oral anticoagulant use. Pharmacoepidemiol Drug Saf. 2011;20(6):560\u20136. https:\/\/doi.org\/10.1002\/pds.2109.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"2","key":"1940_CR17","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/pst.433","volume":"10","author":"PC Austin","year":"2011","unstructured":"Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150\u201361. https:\/\/doi.org\/10.1002\/pst.433.","journal-title":"Pharm Stat"},{"issue":"23","key":"1940_CR18","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2020.7819","volume":"323","author":"LE Thomas","year":"2020","unstructured":"Thomas LE, Li F, Pencina MJ. Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial. JAMA. 2020;323(23):2417\u20138. https:\/\/doi.org\/10.1001\/jama.2020.7819.","journal-title":"JAMA"},{"issue":"1","key":"1940_CR19","doi-asserted-by":"publisher","first-page":"e82","DOI":"10.1055\/a-2013-3346","volume":"7","author":"N Sood","year":"2023","unstructured":"Sood N, Ashton V, Bessada Y, et al. Effectiveness and safety of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients with concomitant obstructive sleep apnea. TH Open. 2023;7(1):e82\u201393. https:\/\/doi.org\/10.1055\/a-2013-3346.","journal-title":"TH Open"},{"issue":"7","key":"1940_CR20","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1080\/03007995.2020.1762554","volume":"36","author":"OS Costa","year":"2020","unstructured":"Costa OS, Beyer-Westendorf J, Ashton V, et al. Effectiveness and safety of rivaroxaban versus warfarin in obese nonvalvular atrial fibrillation patients: analysis of electronic health record data. Curr Med Res Opin. 2020;36(7):1081\u20138. https:\/\/doi.org\/10.1080\/03007995.2020.1762554.","journal-title":"Curr Med Res Opin"},{"issue":"10","key":"1940_CR21","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1056\/NEJMoa1009638","volume":"365","author":"MR Patel","year":"2011","unstructured":"Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883\u201391. https:\/\/doi.org\/10.1056\/NEJMoa1009638.","journal-title":"N Engl J Med"},{"key":"1940_CR22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ahj.2020.01.001","volume":"223","author":"F Dalgaard","year":"2020","unstructured":"Dalgaard F, North R, Pieper K, et al. Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation. Am Heart J. 2020;223:65\u201371. https:\/\/doi.org\/10.1016\/j.ahj.2020.01.001.","journal-title":"Am Heart J"},{"issue":"12","key":"1940_CR23","doi-asserted-by":"publisher","first-page":"e20770","DOI":"10.7759\/cureus.20770","volume":"13","author":"A Brgdar","year":"2021","unstructured":"Brgdar A, Yi J, Awan A, et al. Impact of obstructive sleep apnea on in-hospital outcomes in patients with atrial fibrillation: a retrospective analysis of the National Inpatient Sample. Cureus. 2021;13(12):e20770. https:\/\/doi.org\/10.7759\/cureus.20770.","journal-title":"Cureus"},{"issue":"2","key":"1940_CR24","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1161\/STROKEAHA.120.030285","volume":"52","author":"MF Pengo","year":"2021","unstructured":"Pengo MF, Faini A, Grote L, et al. Impact of sleep apnea on cardioembolic risk in patients with atrial fibrillation: data from the ESADA cohort. Stroke. 2021;52(2):712\u20135. https:\/\/doi.org\/10.1161\/STROKEAHA.120.030285.","journal-title":"Stroke"},{"issue":"4","key":"1940_CR25","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.amjcard.2014.11.027","volume":"115","author":"DM Yaranov","year":"2015","unstructured":"Yaranov DM, Smyrlis A, Usatii N, et al. Effect of obstructive sleep apnea on frequency of stroke in patients with atrial fibrillation. Am J Cardiol. 2015;115(4):461\u20135. https:\/\/doi.org\/10.1016\/j.amjcard.2014.11.027.","journal-title":"Am J Cardiol"}],"container-title":["Journal of Interventional Cardiac Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10840-024-01940-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10840-024-01940-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10840-024-01940-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T06:58:46Z","timestamp":1749884326000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10840-024-01940-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,25]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["1940"],"URL":"https:\/\/doi.org\/10.1007\/s10840-024-01940-6","relation":{},"ISSN":["1572-8595"],"issn-type":[{"value":"1572-8595","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,25]]},"assertion":[{"value":"19 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AN has served as a consultant for Abbott, Biosense Webster, Biotronik, Boston Scientific, iRhythm, and Janssen Scientific Affairs, LLC. SM has nothing to disclose. CC, YZ, AKC, BB, and VA are employees of Janssen Scientific Affairs, LLC and hold stock in Johnson & Johnson.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}