Abstract MP75: Geographic Variation in Stroke Rates and Oral Anticoagulation Use among Medicare Beneficiaries with Atrial Fibrillation

Background: Recent studies have shown strong geographic variation in oral anticoagulation (OAC) use in atrial fibrillation (AF); however, it remains unknown how this contributes to the geographic variation in ischemic stroke observed across the US. The objective of the present study was to evaluate the relationship between the geographic variation in the initiation of OAC and the incidence of ischemic stroke in a cohort of Medicare beneficiaries newly diagnosed with AF. Methods: Using 2013-2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 and categorized them according to their initiation of OAC. Our sample included 21,226 OAC initiators and 20,068 patients who did not initiate OAC therapy. We assigned each patient to one of the 9 US Census Divisions using the zip code, and collected their medical claims with a diagnosis of ischemic stroke. We constructed logistic regression models to estimate the average adjusted probability of OAC initiation and Poisson models to estimate the average adjusted rate of ischemic stroke, in each Census Division. Both estimates were adjusted for demographics, eligibility for Medicaid coverage and for low-income subsidy, enrollment in a Medicare Advantage Part D plan, and a comprehensive list of clinical characteristics. We computed the correlation between the average adjusted probability of OAC initiation and the average adjusted rate of ischemic stroke at the Census Division level. Results: The probability of OAC initiation was lowest in the West South Central (0.47) and highest in the West North Central (0.54) and New England (0.54). The average adjusted rate of ischemic stroke was lowest in the West North Central (0.09) and highest in the South Atlantic (0.14) and South West Central (0.14). The average adjusted probability of OAC initiation at the Census Division level and the average adjusted rate of ischemic stroke were inversely correlated, with R=-0.576, p-value=0.10. This suggests that variation in OAC initiation likely explains at least a third of geographic variation in ischemic stroke [R 2 =(-0.576) 2 =0.332]. Conclusions: Our results suggest that geographic variations in OAC initiation within the U.S. explain, in part, variations in the incidence of ischemic stroke among AF patients. Further mechanistic research using advanced causal mediation models is warranted.

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Meropenem-Vaborbactam Activity against Carbapenem-Resistant Enterobacterales Isolates Collected in U.S. Hospitals during 2016 to 2018

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01951-19 ◽

2019 ◽

Vol 64 (2) ◽

Cited By ~ 3

Author(s):

Mariana Castanheira ◽

Timothy B. Doyle ◽

Valerie Kantro ◽

Rodrigo E. Mendes ◽

Dee Shortridge

Keyword(s):

The Other ◽

The West ◽

North Central ◽

Central Division ◽

Census Division ◽

Middle Atlantic ◽

Carbapenem Resistant ◽

South Central ◽

West North Central

The activities of meropenem-vaborbactam and comparators against 152 (1.1%) carbapenem-resistant Enterobacterales (CRE) isolates identified among 13,929 Enterobacterales isolates collected from U.S. hospitals during 2016 to 2018 were evaluated. CRE rates were higher in the Middle Atlantic census division (3.5%) than in the other divisions (range, 0.0% for the West North Central division to 1.4% for the West South Central division).

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PRE-BONNEVILLE LAKES IN CACHE VALLEY AND EXCAVATION OF CUTLER NARROWS ACROSS THE CACHE BUTTE DIVIDE IN THE WEST, NORTH-CENTRAL UTAH AND SOUTHEASTERN IDAHO

10.1130/abs/2020rm-346804 ◽

2020 ◽

Author(s):

Robert Q. Oaks ◽

◽

Susanne U. Janecke ◽

Tammy M. Rittenour ◽

Thad L. Erickson ◽

...

Keyword(s):

The West ◽

North Central ◽

Cache Valley ◽

West North Central

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PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK

PEDIATRICS ◽

10.1542/peds.2.1.138 ◽

1948 ◽

Vol 2 (1) ◽

pp. 138-140

Keyword(s):

Public Health ◽

South Carolina ◽

New England ◽

The West ◽

Central Section ◽

North Central ◽

South Central ◽

High Incidence ◽

Health Nursing ◽

West North Central

THE accompanying table summarizes the incidence of nine important communicable diseases, based on weekly telegraphic reports from State health departments. The reports from each State for each week are published in PUBLIC HEALTH REPORTS under the section "Incidence of Disease." [See Table in Source Pdf]. Diseases Above Median Incidence Measles—The number of cases of measles rose from 102,680 during the preceding 4 weeks to 114,983 during the 4 weeks ended May 22. The incidence was 3.4 times the number of cases reported for the corresponding period in 1947, which was, however, a comparatively low measles year, but it was only about 10 percent above the 1943-47 median. In the New England and East South Central sections the incidence was below the normal expectancy and in the South Atlantic section the number of cases was only slightly higher than the median for the preceding 5 years, but in the other 6 sections the increases over the median expectancy ranged from 1.1 times the median in the West North Central section to 3.4 times the median in the West South Central section. Poliomyelitis.— The number of cases of poliomyelitis rose from 126 during the preceding 4-week period to 440 during the current 4 weeks. The incidence was 3.5 times that reported for these weeks in 1947, which number (126 cases) also represents the 1943-47 median. An increase of this disease is expected at this season of the year, but the current number of cases represents a larger increase at this time than has normally occurred in preceding years. While each section of the country except New England contributed to the relatively high incidence, the greatest excesses over the 5-year medians were reported from the West North Central and West South Central sections. Of the total cases Texas reported 179, California 62, South Carolina 46, New Jersey 16, Iowa 14, Florida 12, Alabama 11, and Illinois, South Dakota, and Louisiana 10 each; 85 percent of the reported cases occurred in those 10 states which represent every section of the country except the New England and Mountain sections. Since the beginning of the year there have been 947 cases of poliomyelitis reported as compared with 894 and 810 for the corresponding period in 1947 and 1946, respectively.

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Clustering of healthy lifestyle behaviors is associated with a lower incidence of adverse events in patients with newly diagnosed atrial fibrillation: a nationwide cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0336 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S R Lee ◽

E K Choi ◽

K D Han ◽

S Oh ◽

G Y H Lip

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Adverse Events ◽

Healthy Lifestyle ◽

Health Screening ◽

Major Adverse Cardiovascular Events ◽

Lifestyle Behaviors ◽

Newly Diagnosed ◽

Healthy Lifestyle Behaviors

Abstract Background Although unhealthy or healthy lifestyle behaviors tend to be clustered, studies on the risk of clinical outcomes depending on how the lifestyle behaviors are managed after atrial fibrillation (AF) diagnosis remain limited. Purpose We aimed to evaluate the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. Methods Using the Korean National Insurance Service database, patients who were newly diagnosed as nonvalvular AF between 2009 and 2016 and received national health screening examination within 2-year after AF diagnosis were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for “non-current” smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health screening examinations. The primary outcome was defined as major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. The secondary outcomes included individual components of the primary composite outcome and all-cause death. Results A total of 208,662 patients were included and 7.1%, 22.7%, 58.6%, and 11.6% were HLS 0, 1, 2, and 3 group, respectively. After multivariable adjustment, patients with HLS 1, 2, and 3 were associated with lower risks of MACE compared to those with HLS 0 (adjusted hazard ratio [95% confidence interval]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively) (Figure). Increased number of healthy lifestyle behaviors were associated with lower risks of ischemic stroke, hospitalization for heart failure, and all-cause death. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of CHA2DS2-VASc score and oral anticoagulant use. Conclusion Increased number of healthy lifestyle behaviors were significantly associated with lower MACE and all-cause death risks in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

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SOME ASPECTS OF THE SPATIAL DISTRIBUTION OF POPULATION CHANGE IN THE WEST NORTH CENTRAL STATES∗

The Professional Geographer ◽

10.1111/j.0033-0124.1962.00017.x ◽

1962 ◽

Vol 14 (1) ◽

pp. 17-23 ◽

Cited By ~ 1

Author(s):

Herbert G. Kariel

Keyword(s):

Spatial Distribution ◽

Population Change ◽

The West ◽

North Central ◽

West North Central

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Abstract 12096: Temporal Trends in Ischemic Stroke and Anticoagulation Therapy Among Medicare Beneficiaries Having Non-Valvular Atrial Fibrillation With and Without Diabetes Mellitus, 1992-2010

Circulation ◽

10.1161/circ.130.suppl_2.12096 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Gautam R Shroff ◽

Craig A Solid ◽

Charles A Herzog

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Temporal Trends ◽

Significant Proportion ◽

Anticoagulation Therapy ◽

Medicare Beneficiaries ◽

Similar Reduction ◽

Increased Risk ◽

Patients With Diabetes

Background: Patients with diabetes mellitus (DM) and non valvular atrial fibrillation (AF) are at increased risk of ischemic stroke; but evidence regarding ischemic stroke and warfarin use in the literature is limited. We evaluated temporal trends in ischemic stroke and warfarin use among the US Medicare population with and without DM. Methods: One-year cohorts of patients with Medicare as primary payer, 1992-2010, were created using the Medicare 5% sample. ICD-9-CM codes were used to identify AF, ischemic and hemorrhagic stroke and comorbidities; ≤3 consecutive prothrombin-time claims were used to identify warfarin use. Results: Demographic characteristics between 1992 (n=40255) and 2010 (n=80314) respectively were (proportions): age 65-74 years (37%, 32%); age ≤ 85 years (20%, 25%); white (94%, 93%); hypertension (46%, 80%); DM (20%, 32%), chronic kidney disease (5%, 18%). Ischemic stroke rates among Medicare AF patients with DM decreased by 71% (1992, 2010) from 65 to 19 /1000 patient-years; warfarin utilization increased from 28% to 62% respectively (Figure 1A). Among Medicare AF patients without DM, ischemic stroke rates decreased by 68% from 44 to 14/ 1000 patient-years; warfarin use increased 26% to 59% respectively (Figure 1B). About 38% Medicare AF pts with DM did not receive anticoagulation in 2010. Conclusion: Medicare patients with and without DM had a similar reduction in ischemic stroke rates; and similar increase in warfarin utilization over the study period. A significant proportion of Medicare pts with DM did not receive anticoagulation with warfarin for AF in 2010; this population deserves future attention.

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