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Anticoagulant use for the prevention of stroke in patients with atrial fibrillation: findings from a multi-payer analysis.

Lang K, Bozkaya D, Patel AA, Macomson B, Nelson W, Owens G, Mody S, Schein J, Menzin J - BMC Health Serv Res (2014)

Bottom Line: Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively.The AQuIA provided a consistent platform for analysis across multiple AF populations with varying baseline characteristics.Analyzer results show that many high-risk AF patients in selected commercial, Medicare-eligible, and Medicaid populations do not receive appropriate thromboprophylaxis, as recommended by treatment guidelines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Boston Health Economics, Inc, Waltham, MA, USA. jmenzin@bhei.com.

ABSTRACT

Background: Oral anticoagulation is recommended for stroke prevention in intermediate/high stroke risk atrial fibrillation (AF) patients. The objective of this study was to demonstrate the usefulness of analytic software tools for descriptive analyses of disease management in atrial AF; a secondary objective is to demonstrate patterns of potential anticoagulant undertreatment in AF.

Methods: Retrospective data analyses were performed using the Anticoagulant Quality Improvement Analyzer (AQuIA), a software tool designed to analyze health plan data. Two-year data from five databases were analyzed: IMS LifeLink (IMS), MarketScan Commercial (MarketScanCommercial), MarketScan Medicare Supplemental (MarketScanMedicare), Clinformatics™ DataMart, a product of OptumInsight Life Sciences (Optum), and a Medicaid Database (Medicaid). Included patients were ≥ 18 years old with a new or existing diagnosis of AF. The first observed AF diagnosis constituted the index date, with patient outcomes assessed over a one year period. Key study measures included stroke risk level, anticoagulant use, and frequency of International Normalized Ratio (INR) monitoring.

Results: High stroke risk (CHADS2 ≥ 2 points) was estimated in 54% (IMS), 22% (MarketScanCommercial), 64% (MarketscanMedicare), 42% (Optum) and 62% (Medicaid) of the total eligible population. Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively. Among patients at high risk for stroke, 19% to 51% received any anticoagulant.

Conclusions: The AQuIA provided a consistent platform for analysis across multiple AF populations with varying baseline characteristics. Analyzer results show that many high-risk AF patients in selected commercial, Medicare-eligible, and Medicaid populations do not receive appropriate thromboprophylaxis, as recommended by treatment guidelines.

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Proportion of AF patients in each CHADS2 stroke risk level.
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Figure 1: Proportion of AF patients in each CHADS2 stroke risk level.

Mentions: The number of patients meeting the cohort selection criteria varied across databases (Table 1); 30,757 IMS, 21,976 MarketScanCommercial, 38,643 MarketScanMedicare, 9,120 Optum, 4,901 Medicaid. Average age varied between 56 and 80 years, with MarketScanCommercial and Optum databases having generally younger populations. More than half of study patients were male, with the exception of the Medicaid database. Most patients were high risk, stratified according to CHADS2 or CHA2DS2-VASc scores (Figures 1, 2). In general, more than 50% of the patients had hypertension in the study period. Diabetes and coronary heart disease were other commonly observed conditions.


Anticoagulant use for the prevention of stroke in patients with atrial fibrillation: findings from a multi-payer analysis.

Lang K, Bozkaya D, Patel AA, Macomson B, Nelson W, Owens G, Mody S, Schein J, Menzin J - BMC Health Serv Res (2014)

Proportion of AF patients in each CHADS2 stroke risk level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126814&req=5

Figure 1: Proportion of AF patients in each CHADS2 stroke risk level.
Mentions: The number of patients meeting the cohort selection criteria varied across databases (Table 1); 30,757 IMS, 21,976 MarketScanCommercial, 38,643 MarketScanMedicare, 9,120 Optum, 4,901 Medicaid. Average age varied between 56 and 80 years, with MarketScanCommercial and Optum databases having generally younger populations. More than half of study patients were male, with the exception of the Medicaid database. Most patients were high risk, stratified according to CHADS2 or CHA2DS2-VASc scores (Figures 1, 2). In general, more than 50% of the patients had hypertension in the study period. Diabetes and coronary heart disease were other commonly observed conditions.

Bottom Line: Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively.The AQuIA provided a consistent platform for analysis across multiple AF populations with varying baseline characteristics.Analyzer results show that many high-risk AF patients in selected commercial, Medicare-eligible, and Medicaid populations do not receive appropriate thromboprophylaxis, as recommended by treatment guidelines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Boston Health Economics, Inc, Waltham, MA, USA. jmenzin@bhei.com.

ABSTRACT

Background: Oral anticoagulation is recommended for stroke prevention in intermediate/high stroke risk atrial fibrillation (AF) patients. The objective of this study was to demonstrate the usefulness of analytic software tools for descriptive analyses of disease management in atrial AF; a secondary objective is to demonstrate patterns of potential anticoagulant undertreatment in AF.

Methods: Retrospective data analyses were performed using the Anticoagulant Quality Improvement Analyzer (AQuIA), a software tool designed to analyze health plan data. Two-year data from five databases were analyzed: IMS LifeLink (IMS), MarketScan Commercial (MarketScanCommercial), MarketScan Medicare Supplemental (MarketScanMedicare), Clinformatics™ DataMart, a product of OptumInsight Life Sciences (Optum), and a Medicaid Database (Medicaid). Included patients were ≥ 18 years old with a new or existing diagnosis of AF. The first observed AF diagnosis constituted the index date, with patient outcomes assessed over a one year period. Key study measures included stroke risk level, anticoagulant use, and frequency of International Normalized Ratio (INR) monitoring.

Results: High stroke risk (CHADS2 ≥ 2 points) was estimated in 54% (IMS), 22% (MarketScanCommercial), 64% (MarketscanMedicare), 42% (Optum) and 62% (Medicaid) of the total eligible population. Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively. Among patients at high risk for stroke, 19% to 51% received any anticoagulant.

Conclusions: The AQuIA provided a consistent platform for analysis across multiple AF populations with varying baseline characteristics. Analyzer results show that many high-risk AF patients in selected commercial, Medicare-eligible, and Medicaid populations do not receive appropriate thromboprophylaxis, as recommended by treatment guidelines.

Show MeSH
Related in: MedlinePlus