Abstract 240: Survey of Patients With Atrial Fibrillation on the Use of Warfarin and the Newer Anticoagulant, Dabigatran

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Jiyoon Choi ◽  
Marco DiBonaventura ◽  
Lewis Kopenhafer ◽  
Winnie Nelson
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Options ◽  
Insurance Coverage ◽  
Anticoagulation Therapy ◽  
Patient Characteristics ◽  
Continuous Variables ◽  
Real World Data ◽  
Chi Squared ◽  
Usage Patterns ◽  
Physician Prescribing

BACKGROUND: In 2010 and 2011, U.S. atrial fibrillation (AF) patients had two choices for oral anticoagulation therapy. However, limited real world data exist as to the patient characteristics, usage patterns, and medication perceptions of patients on these newer treatments. OBJECTIVE: To describe and compare characteristics of AF patients who have used warfarin or the newer anticoagulant, dabigatran. METHODS: Patient surveys were conducted via phone or internet from September 2011 to November 2011. Study patients were ≥18 years old, had a diagnosis of AF, and have used either warfarin or the newer anticoagulant, dabigatran. Characteristics differences were tested using chi-squared and ANOVA for categorical and continuous variables, respectively. RESULTS: We surveyed 361 patients. Of those, 204 were warfarin users and 160 were newer anticoagulant users (NAU). Mean patient age was 65.1. Patients were predominantly male (68.7%) and non-Hispanic white (91.2%). Nearly half (44.0%) of patients were obese and more than half (58.0%) had a Charlson Comorbidity Index (CCI) of ≥1. Average number of years with an AF diagnosis was 7. Patients were taking 6.26 medications on average. NAU were more likely to be female (36.9% vs. 27.0%), younger (60.93 vs. 68.36 years), diagnosed more recently (5.78 vs. 8.10 years), and had more education compared to warfarin patients (all p<.05). Levels of obesity (31.9% vs. 53.4%) and CCI burden of ≥1 (51.9% vs. 62.7%) were lower among NAU (p<.05). NAU were more likely to use an OTC medication (38.7% vs. 12.1%) or both a prescription and OTC medication (11.3% vs. 4.3%) to treat stomach-related symptoms (p<.05). NAU were more likely to have had a discussion about their treatment options with their physicians (36.9% vs. 24.5%) rather than have their physician prescribing (60.6% vs. 73.5%) (p<.05). NAU were significantly less likely to have considered switching their medication (10.7% vs. 31.9%). Among those considered switching, cost (62.5%) and insurance coverage (18.8%) were the most common reasons for NAU, and inconvenience factors (“too much of a hassle”; 19.5% and “interfering with my lifestyle”; 12.2%) for warfarin users. CONCLUSIONS: There were some characteristic differences among AF patients. Understanding patients' characteristics may be the first step in helping patients to be adherent to their stroke prevention medications.

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

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Michael H Kim ◽  
Kelly F Bell ◽  
Dinara Makenbaeva ◽  
Daniel Daniel Wiederkehr ◽  
Jay Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Insurance Coverage ◽  
Anticoagulation Therapy ◽  
Patient Characteristics ◽  
Nonvalvular Atrial Fibrillation ◽  
Chads2 Score ◽  
Entire Study ◽  
Healthcare Burden ◽  
Gi Bleed

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.

458Real world persistence with direct oral anticoagulants in anticoagulation naive patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Denas ◽  
G Costa ◽  
E Ferroni ◽  
N Gennaro ◽  
U Fedeli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Anatomical Therapeutic Chemical ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Female Gender ◽  
Population Based ◽  
Real World Data

Abstract Introduction Anticoagulation therapy is central for the management of stroke in patients with non-valvular atrial fibrillation (NVAF). Persistence with oral anticoagulation is essential to prevent thromboembolic complications. Purpose To assess persistence levels of DOACs and look for possible predictors of treatment discontinuity in NVAF patients. Methods We performed a population-based retrospective cohort study in the Veneto Region (north-eastern Italy, about 5 million inhabitants) using the regional health system databases. Naïve patients initiating direct oral anticoagulants (DOACs) for stroke prevention in NVAF from July 2013 to September 2017 were included in the study. Patients were identified using Anatomical Therapeutic Chemical (ATC) codes, excluding other indications for anticoagulation therapy using ICD-9CM codes. Treatment persistence was defined as the time from initiation to discontinuation of the therapy. Baseline characteristics and comorbidities associated to the persistence of therapy with DOACs were explored by means of Kaplan-Meier curves and assessed through Cox regression. Results Overall, 17920 patients initiated anticoagulation with DOACs in the study period. Most patients were older than 74 years old, while gender was almost equally represented. Comorbidities included hypertension (72%), diabetes mellitus (17%), congestive heart failure (9%), previous stroke/TIA (20%), and prior myocardial infarction (2%). After one year, the persistence to anticoagulation treatment was 82.7%, while the persistence to DOAC treatment was 72.9% with about 10% of the discontinuations being due to switch to VKAs. On multivariate analysis, factors negatively affecting persistence were female gender, younger age (<65 years), renal disease and history of bleeding. Conversely, persistence was better in patients with hypertension, previous cerebral ischemic events, and previous acute myocardial infarction. Persistence to DOAC therapy Conclusion This real-world data show that within 12 months, one out of four anticoagulation-naïve patients stop DOACs, while one out of five patients stop anticoagulation. Efforts should be made to correct modifiable predictors and intensify patient education.

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

Does Incidental Appendectomy Increase the Risk of Complications after Abdominal Procedures?

2016 ◽  
Vol 82 (10) ◽  
pp. 885-889 ◽  
Author(s):  
Mohammed Al-Temimi ◽  
Charles Trujillo ◽  
John Agapian ◽  
Hanna Park ◽  
Ahmad Dehal ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Multivariate Logistic Regression Analysis ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Wound Complications ◽  
Continuous Variables ◽  
Improvement Program ◽  
Increased Risk ◽  
Chi Squared ◽  
Incidental Appendectomy

Incidental appendectomy (IA) could potentially increase the risk of morbidity after abdominal procedures; however, such effect is not clearly established. The aim of our study is to test the association of IA with morbidity after abdominal procedures. We identified 743 (0.37%) IA among 199,233 abdominal procedures in the National Surgical Quality Improvement Program database (2005–2009). Cases with and without IA were matched on the index current procedural terminology code. Patient characteristics were compared using chi-squared test for categorical variables and Student t test for continuous variables. Multivariate logistic regression analysis was performed. Emergency and open surgeries were associated with performing IA. Multivariate analysis showed no association of IA with mortality [odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.26–1.02], overall morbidity (OR = 1.16, 95% CI = 0.92–1.47), or major morbidity (OR = 1.20, 95% CI = 0.99–1.48). However, IA increased overall morbidity among patients undergoing elective surgery (OR = 1.31,95% CI = 1.03–1.68) or those ≥30 years old (OR = 1.23, 95% CI = 1.00–1.51). IA was also associated with higher wound complications (OR = 1.46,95% CI = 1.05–2.03). In conclusion, IA is an uncommonly performed procedure that is associated with increased risk of postoperative wound complications and increased risk of overall morbidity in a selected patient population.

scholarly journals Comparison of Atrial Fibrillation in the Young versus That in the Elderly: A Review

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Rajiv Sankaranarayanan ◽  
Graeme Kirkwood ◽  
Katharine Dibb ◽  
Clifford J. Garratt
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Treatment Options ◽  
Management Strategies ◽  
Young Patients ◽  
Patient Characteristics ◽  
The Elderly ◽  
Diagnostic Techniques ◽  
Significant Burden ◽  
Acting In Concert

The incidence and prevalence of atrial fibrillation (AF) are projected to increase significantly worldwide, imposing a significant burden on healthcare resources. The disease itself is extremely heterogeneous in its epidemiology, pathophysiology, and treatment options based on individual patient characteristics. Whilst ageing is well recognised to be an independent risk factor for the development of AF, this condition also affects the young in whom the condition is frequently symptomatic and troublesome. Traditional thinking suggests that the causal factors and pathogenesis of the condition in the young with structurally normal atria but electrophysiological “triggers” in the form of pulmonary vein ectopics leading to lone AF are in stark contrast to that in the elderly who have AF primarily due to an abnormal substrate consisting of fibrosed and dilated atria acting in concert with the pulmonary vein triggers. However, there can be exceptions to this rule as there is increasing evidence of structural and electrophysiological abnormalities in the atrial substrate in young patients with “lone AF,” as well as elderly patients who present with idiopathic AF. These reports seem to be blurring the distinction in the pathophysiology of so-called idiopathic lone AF in the young versus that in the elderly. Moreover with availability of improved and modern investigational and diagnostic techniques, novel causes of AF are being reported thereby seemingly consigning the diagnosis of “lone AF” to a rather mythical existence. We shall also elucidate in this paper the differences seen in the epidemiology, causes, pathogenesis, and clinical features of AF in the young versus that seen in the elderly, thereby requiring clearly defined management strategies to tackle this arrhythmia and its associated consequences.

scholarly journals Incidence, treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001226
Author(s):  
Maartje S Jacobs ◽  
Bert Loef ◽  
Auke C Reidinga ◽  
Maarten J Postma ◽  
Marinus Van Hulst ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stroke Prevention ◽  
Patient Characteristics ◽  
Real World Data ◽  
New Onset

ObjectiveCritically ill patients admitted to the intensive care unit (ICU) often develop atrial fibrillation (AF), with an incidence of around 5%. Stroke prevention in AF is well described in clinical guidelines. The extent to which stroke prevention is prescribed to ICU patients with AF is unknown. We aimed to determine the incidence of new-onset AF and describe stroke prevention strategies initiated on the ICU of our teaching hospital. Also, we compared mortality in patients with new-onset AF to critically ill patients with previously diagnosed AF and patients without any AF.MethodsThis study was a retrospective cohort study including all admissions to the ICU of the Martini Hospital (Groningen, The Netherlands) in the period 2011 to 2016. Survival analyses were performed using these real-world data.ResultsIn total, 3334 patients were admitted to the ICU, of whom 213 patients (6.4%) developed new-onset AF. 583 patients (17.5%) had a previous AF diagnosis, the other patients were in sinus rhythm. In-hospital mortality and 1-year mortality after hospital discharge were significantly higher for new-onset AF patients compared with patients with no history of AF or previously diagnosed AF. At hospital discharge, only 56.3% of the new-onset AF-patients eligible for stroke prevention received an anticoagulant. Anticoagulation was not dependent on CHA2DS2-VASc score or other patient characteristics. An effect of anticoagulative status on mortality was not significant.ConclusionAF is associated with increased mortality in critically ill patients admitted to the ICU. More guidance is needed to optimise anticoagulant treatment in critically ill new-onset AF patients.

scholarly journals Comparing medical cannabis use in 5 US states: a retrospective database study

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
V. Kishan Mahabir ◽  
Christopher S. Smith ◽  
Christopher Vannabouathong ◽  
Jamil J. Merchant ◽  
Alisha L. Garibaldi
Keyword(s):  
Chronic Pain ◽  
Medical Condition ◽  
Patient Characteristics ◽  
Medical Cannabis ◽  
Post Traumatic Stress ◽  
Real World Data ◽  
Us States ◽  
Medical Certification ◽  
Chi Squared ◽  
Depth Study

Abstract Background US states have been adopting their own medical cannabis laws since 1996. There is substantial variability in the medical cannabis programs between states, and these differences have not been thoroughly investigated in the literature. The objective of the study was to compare medical cannabis patient characteristics across five states to identify differences potentially caused by differing policies surrounding condition eligibility. Methods We conducted secondary analyses following a retrospective study of a registry database with data from 33 medical cannabis evaluation clinics in the US, owned and operated by CB2 Insights. This study narrowed the dataset to include patients from five states with the largest samples: Massachusetts (n = 27,892), Colorado (n = 16,434), Maine (n = 4591), Connecticut (n = 2643), and Maryland (n = 2403) to conduct an in-depth study of the characteristics of patients accessing medical cannabis in these states, including analysis of variance to compare average ages and number of conditions and chi-squared tests to compare proportions of patient characteristics between states. Results Average ages varied between the states, with the youngest average in Connecticut (42.2) and the oldest in Massachusetts (47.0). Males represented approximately 60% of the patients with data on gender in each state. The majority of patients in each state had cannabis experience prior to seeking medical certification. Primary medical conditions varied for each state, with chronic pain, anxiety, and back and neck problems topping the list in varying orders for Massachusetts, Maine, and Maryland. Colorado had 78.7% of patients report chronic pain as their primary condition, and 70.4% of patients in Connecticut reported post-traumatic stress disorder as their primary medical condition. Conclusion This study demonstrated the significant impact that policy has on patients’ access to medical cannabis in Massachusetts, Colorado, Maine, Connecticut, and Maryland utilizing real-world data. It highlights how qualifications differ between the five states and brings into question the routes through which patients in states with stricter regulations surrounding eligible conditions choose to seek treatment with cannabis. These patients may turn to alternative treatments, or to the illicit or recreational cannabis markets, where permitted.

Clinical outcomes of first-line FOLFIRINOX versus gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer at the Yale Smilow Healthcare System.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 769-769
Author(s):  
Timil Patel ◽  
Thejal Srikumar ◽  
Joseph Anthony Miccio ◽  
Jill Lacy ◽  
Stacey Stein ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Metastatic Pancreatic Cancer ◽  
Continuous Variables ◽  
First Line ◽  
Real World Data ◽  
Prior Therapy ◽  
Kaplan Meier ◽  
Chi Squared ◽  
Treatment Data ◽  
Prior Surgery

769 Background: FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GN) are established first line (1L) therapies for metastatic pancreatic cancer (MPC) but real-world data on their comparative effectiveness is limited. Methods: All cases of MPC treated with 1L FFX or GN at Yale Smilow Cancer Hospital and the affiliated community care centers (CCC) from January 2011 – April 2019 were reviewed. Patient (pt) demographics, prior therapy, initial and subsequent dose reductions (DR), time to treatment discontinuation (TTD), overall survival (OS), and second line (2L) treatment data were manually abstracted from the electronic medical record. Categorical and continuous variables were compared between 1L FFX and GN cohorts via the Chi-squared and Wilcoxon rank-sum tests. Median OS was calculated by the Kaplan-Meier method. Results: We identified 363 MPC pts treated with 1L FFX or GN; 269 (74%) pts were treated with FFX and 94 (26%) with GN as 1L therapy. 204 (56%) pts were treated at the main campus and 159 (44%) at a CCC. Demographics and baseline characteristics (FFX/GN) were as follows: gender (male) 55% / 41%; race (white) 82% / 77%; age < 76 90% / 71% ( P < 0.001). 332 (91%) of pts received no prior therapy; 21 (6%) had prior surgery plus adjuvant gemcitabine and 10 (3%) had surgery alone. 98% of FFX-treated pts were treated with upfront DR, compared to 78% of GN-treated pts ( P= 0.003). 78% and 53% of FFX-treated and GN-treated pts, respectively, had subsequent DR ( P< 0.001). Median TTD was 4.8 months with FFX and 3.4 months with GN ( P= 0.0029) and the median OS was 11.3 months with FFX versus 7.2 months with GN ( P < 0.0001). After 1L, 33% and 61% of FFX- and GN-treated pts, respectively, received no further chemotherapy ( P< 0.001). Conclusions: In the largest manually abstracted retrospective analysis to date, MPC pts treated with 1L FFX were younger, more likely to receive 2L therapy, and had increased survival compared to pts treated with GN. The OS of pts treated with FFX was similar to the OS reported by Conroy et al despite upfront dose attenuations in 98% of pts. A randomized trial is needed to confirm optimal sequencing of chemotherapy in MPC.

scholarly journals Failure of non-vitamin K antagonist oral anticoagulants in preventing stroke in elderly patient: a case report of multiple strokes on standard of care treatment for atrial fibrillation

2021 ◽  
Vol 8 (1) ◽  
pp. 1-6
Author(s):  
Frank Bernard Ebai ◽  
Azam Mohiuddin
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Treatment Options ◽  
Anticoagulation Therapy ◽  
Standard Of Care ◽  
The Elderly ◽  
Vitamin K Antagonist ◽  
Heart Arrhythmia ◽  
Standard Of Care Treatment

Atrial fibrillation (AF) is the most common type of treated heart arrhythmia. Generally, the treatment goals for atrial fibrillation are to reset the rhythm or control the rate and prevent the development and subsequent embolization of atrial thrombi. These thromboembolic events can occur with any kind of atrial fibrillation that is paroxysmal, persistent or permanent. In patients who are candidate for anticoagulation therapy, major practice guideline provides vitamin K antagonist (VKA) oral anticoagulant and non-VKA oral anticoagulants as treatment options. The risk of AF increases with age and despite treatment on standard of care anticoagulation therapy, recrudescent cardioembolic events may still arise especially in the elderly as we will see in this case.

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