Abstract
BackgroundOral 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.MethodsRetrospective 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.ResultsHigh 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.ConclusionsThe 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.
Highlights
Oral anticoagulation is recommended for stroke prevention in intermediate/high stroke risk atrial fibrillation (AF) patients
Diagnoses and procedures were identified based on International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT) codes from patients’ medical claims, while medication use was assessed based on National Drug Codes (NDC) from patients’ pharmacy claims
Demographic and clinical characteristics 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 OptumInsight Life Sciences (Optum), 4,901 Medicaid
Summary
Oral anticoagulation is recommended for stroke prevention in intermediate/high stroke risk atrial fibrillation (AF) patients. Thromboprophylaxis with oral anticoagulants involving warfarin or other agents is the mainstay for stroke prevention, reducing the annual incidence of stroke in AF patients by more than 60% [6]. Among patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry, only 59% of the high risk patients with AF were treated with oral anticoagulants [8]. While contraindications may contribute to low rates of anticoagulation, recently released results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) show that rates of anticoagulation as high as 80% among AF patients with high stroke risk (88% among patients without contraindications) are attainable [9]
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