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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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Anticoagulant use among AF patients, stratified by CHADS2 stroke risk level.
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Figure 3: Anticoagulant use among AF patients, stratified by CHADS2 stroke risk level.

Mentions: The overall percentage of patients receiving anticoagulants was less than 50% in all five databases (Table 2) ranging from 16%-39%; these rates were slightly higher among patients at high risk of stroke according to CHADS2 score (Figure 3). The anticoagulant MPR varied from 0.58 to 0.72 across all five databases. 29% to 59% of the patients had a gap in anticoagulant therapy. The time to first gap in anticoagulation therapy varied from 129 to 166 days across different databases.


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)

Anticoagulant use among AF patients, stratified by 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 3: Anticoagulant use among AF patients, stratified by CHADS2 stroke risk level.
Mentions: The overall percentage of patients receiving anticoagulants was less than 50% in all five databases (Table 2) ranging from 16%-39%; these rates were slightly higher among patients at high risk of stroke according to CHADS2 score (Figure 3). The anticoagulant MPR varied from 0.58 to 0.72 across all five databases. 29% to 59% of the patients had a gap in anticoagulant therapy. The time to first gap in anticoagulation therapy varied from 129 to 166 days across different databases.

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