Abstract TP399: Incremental Healthcare Burden Associated with Dyspepsia Among Nonvalvular Atrial Fibrillation Patients: Implications for Anticoagulation Therapy

Abstract

Background: Dyspepsia is common among nonvalvular atrial fibrillation (NVAF) patients and may influence stroke preventative medication choice, such as warfarin and dabigatran, especially when bleeding is a concern. This study evaluated the incremental healthcare burden associated with dyspepsia among NVAF patients. Methods: NVAF patients ≥18 years of age with continuous insurance coverage were identified (1/1/2007-12/31/2009) from the MarketScan® Commercial and Medicare Research Databases. Patients with at least 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were categorized as dyspepsia cohort, with patients without any dyspepsia diagnosis during the entire study period categorized as non-dyspepsia cohort. Of the overall dyspepsia/non-dyspepsia cohorts, patients were matched by key patient characteristics. Healthcare usage and costs were measured in a 12-month follow-up period. Results: Among NVAF patients, 10.2% had dyspepsia. For the dyspepsia cohort (n=14,556) vs. unmatched non-dyspepsia cohort (n= 127,766), mean CCI (2.4 vs. 1.6, p<0.0001), CHADS2 score (1.8 vs. 1.6, p<0.0001), hospitalizations (dyspepsia-related, GI-related, GI-bleed related, any cause), associated inpatient costs, outpatient usage and costs, as well as pharmacy usage and costs were greater. After matching, a lesser proportion of patients in the dyspepsia cohort used warfarin (49% vs. 57%, p<0.0001) and had significantly higher healthcare resource usage and costs vs. the non-dyspepsia cohort during the follow-up period (Table). Conclusions: The incremental healthcare burden associated with dyspepsia among NVAF patients is significant and appears associated with less warfarin usage. Further data on dyspepsia as a barrier to anticoagulation in NVAF are needed.