PCV61 - Atrial Fibrillation: Evidence Generation and Practice Improvement. Real World Evidence From Italian Administrative Databases

Abstract

Nemawashi project was developed with two main objectives. Firstly, to measure the degree of adherence to therapeutic recommendations in clinical practice for patients with Atrial Fibrillation prescribed to anticoagulant therapies. Secondly, to enable regular monitoring of appropriateness of prescribing of oral anticoagulant therapies (OACs) in a group of Italian regions, with the aim of reducing the gap between AF treatment recommendations and clinical practice. Phase one of the study was a retrospective study based on administrative databases of healthcare resources consumption (pharmaceuticals, hospitalizations, laboratory tests, diagnostic tests and specialist visits) and laboratory test values database from 5 Italian Local Health Units (LHUs). All patients diagnosed with AF (through ICD-9-CM code or with at least a consumption of healthcare resource due to AF) and treated with OACs or antiplatelet drugs, and with at least one INR-testing from January 1st, 2009 to December 31st, 2013 were included. Preliminary results of phase one have highlighted the relevance and innovative approach of the methodology. Among patients switched to the new oral anticoagulants (NOACs), only 5% did not present the recommendation for therapeutic use of (inappropriateness for excess); by contrast, among patients recommended to NOACs, 72% had not been initiated to that treatment (inappropriateness downward). In terms of consumption of health care resources, the average cost per year of patients recommended to NOACs - but not treated with them - was similar to the one of patients who were recommended and treated with NOACs. The higher cost of therapy of the new oral anticoagulants was completely balanced by lower costs for hospitalizations for cardio-cerebrovascular disease. The decrease of inappropriateness of prescriptions, main focus of phase two of the project, will be essential to reduce hospitalizations for cardio-cerebrovascular diseases and minimize the cost of care of patients with Atrial Fibrillation.