Abstract 13834: Changes in Treatment Patterns and Incremental Healthcare Utilization Due to P2Y 12 Associated Disorders in Patients With Acute Coronary Syndrome

Abstract

Introduction: Data on the effect of P2Y 12 associated disorders on adherence to antiplatelet therapy (APT) in acute coronary syndrome (ACS) patients are sparse. We describe the characteristics, treatment patterns, associated disorders and healthcare utilization (HU) among ACS patients on P2Y 12 APT. Methods: Patients age ≥18 discharged from an ACS hospitalization in 2012-2014 who initiated P2Y 12 APT (ticagrelor, prasugrel, or clopidogrel) were identified from the MarketScan commercial claims database. The proportion of patients within each treatment group who experienced P2Y 12 associated disorders within one year, and who were adherent to APT were determined. Adjusted poisson regressions estimated the association between P2Y 12 non-adherence and HU (hospitalization, emergency visits, outpatient visits, cardiac events, transfusions). Results: Among 11,629 ACS patients, most were male, 45% had hypertension and 21% had diabetes. Clopidogrel use was common, and ticagrelor less common. Among all groups, about a third experienced P2Y 12 associated disorders. One-year adherence to APT was suboptimal (68%) and highest among prasugrel users (71%); switching was most common in ticagrelor users. Non-adherent patients experienced 1.34, 1.09, and 1.85 (p<0.05) times as many hospitalizations, emergency room visits, and transfusions, respectively, compared to adherent patients. Also, patients not adherent to ticagrelor experienced 1.9 times as many cardiac events as adherent patients. However, this association was not significant for clopidogrel or prasugrel users. Conclusions: P2Y 12 associated disorders were common. Adherence was suboptimal and non-adherence was associated with increased HU. Disease management strategies to improve adherence and reduce treatment-associated adverse events through individualized patient care, alternative secondary treatment options and physician awareness should be assessed.