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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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Mean all-cause resource use among AF patients during follow-up.
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Figure 4: Mean all-cause resource use among AF patients during follow-up.

Mentions: About 20% to 40% of the patients had an inpatient hospitalization or ER visit during the study period (Table 3). The average number inpatient hospitalizations varied from 0.62 to 3.62 across all databases (Figure 4). The average number of ER visits per patient was generally low (0.38 to 0.79 across all databases). Most of the patients had an outpatient visit and, on average, patients had more than six visits in the study period.


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)

Mean all-cause resource use among AF patients during follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Mean all-cause resource use among AF patients during follow-up.
Mentions: About 20% to 40% of the patients had an inpatient hospitalization or ER visit during the study period (Table 3). The average number inpatient hospitalizations varied from 0.62 to 3.62 across all databases (Figure 4). The average number of ER visits per patient was generally low (0.38 to 0.79 across all databases). Most of the patients had an outpatient visit and, on average, patients had more than six visits in the study period.

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