scholarly journals Adherence to Rivaroxaban, Dabigatran, and Apixaban for Stroke Prevention in Incident, Treatment-Naïve Nonvalvular Atrial Fibrillation

2016 ◽  
Vol 22 (11) ◽  
pp. 1319-1329 ◽  
Author(s):  
Joshua D. Brown ◽  
Anand R. Shewale ◽  
Jeffery C. Talbert
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Nonvalvular Atrial Fibrillation ◽  
Treatment Naïve

scholarly journals Does Sex Affect Anticoagulant Use for Stroke Prevention in Nonvalvular Atrial Fibrillation?: The Prospective Global Anticoagulant Registry in the FIELD-Atrial Fibrillation

2015 ◽  
Vol 8 (2_suppl_1) ◽  
pp. S12-S20 ◽  
Author(s):  
G. Y. H. Lip ◽  
S. K. Rushton-Smith ◽  
S. Z. Goldhaber ◽  
D. A. Fitzmaurice ◽  
L. G. Mantovani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Nonvalvular Atrial Fibrillation

Abstract 258: Dabigatran Etexilate is Associated with Shorter Hospital Length of Stay and Lower Hospital Costs Compared to Warfarin in Treatment-Naive, Newly-Diagnosed Nonvalvular Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Eileen Fonseca ◽  
David R Walker ◽  
Gregory P Hess
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Cost ◽  
Dabigatran Etexilate ◽  
Hospital Costs ◽  
Hospital Length Of Stay ◽  
Total Hospital Cost ◽  
Newly Diagnosed ◽  
Nonvalvular Atrial Fibrillation ◽  
Total Hospital ◽  
Treatment Naïve

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants (OAC) used to reduce the risk of stroke among patients with nonvalvular atrial fibrillation (AF). However, DE does not require titration and INR monitoring. This study examined whether hospital length of stay (LOS) and total hospital costs differed between the two therapies among treatment-naive, newly-diagnosed AF patients. Methods: LOS and total hospital costs were evaluated for hospitalizations with a primary or secondary discharge diagnosis of atrial fibrillation (AF) between 1/1/2011-3/31/2012, with DE or warfarin administered during hospitalization, and excluding hospitalizations of patients with valvular AF, previously diagnosed with AF, or previously treated with OAC. Hospitalizations were identified from a Charge Detail Masters database containing 397 qualified hospitals. Samples were propensity score matched using nearest neighbor within a caliper of 0.20 standard deviations of the logit, without replacement and a 2:1 match. Differences in LOS and hospital cost were then estimated using generalized linear models, fitted by generalized estimating equations (clustered by hospital) to account for possible correlation between observations. The hospitalization’s charged amount was multiplied by the hospital’s inpatient cost-to-charge ratio to estimate the total hospital cost. Covariates estimating the propensity score, LOS, and costs included patient age, payer type, CHADS 2 and HAS-BLED scores, use of bridging agents, comorbid conditions, and hospital attributes. As a sensitivity analysis, LOS and costs were estimated with the same parameters and covariates among the raw, unbalanced sample. Results: Matched samples included 1,292 warfarin and 646 DE hospitalizations of treatment-naive, newly diagnosed patients out of 4,619 and 715 hospitalizations, respectively. No covariates used in matching had standardized mean differences > 10% after matching. Two comorbidities (thromboembolism, coronary artery disease) had statistically different distributions after matching (DE: 3% vs. warfarin: 8%, p<0.001 and DE: 40% vs. warfarin: 45%, p=0.048); these were included as model covariates. Among the sample, DE had an estimated 0.7 days shorter stay compared to warfarin (DE: 4.8 days vs. warfarin: 5.5 days, p<0.01) and a $2,031 lower estimated total cost (DE: $14,794 vs warfarin: $16,826, p=0.007). Sensitivity analysis confirmed a shorter DE LOS (DE: 5.5 days vs. warfarin: 6.6 days, delta=1.1 days, p<0.01) and a lower DE hospital cost (DE: $18,362 vs. warfarin: $22,602, delta=$4,240, p<0.01). Conclusions: Among hospitalizations of treatment-naive patients newly diagnosed with nonvalvular AF, the hospitalizations during which DE was administered had a shorter LOS and at least a 12% lower total hospital cost compared to hospitalizations where warfarin was administered.

Abstract 95: Nonvalvular Atrial Fibrillation Emergency Department Encounters where Dabigatran Etexilate was Administered are Associated with Lower Admission Rate Compared to Encounters where Warfarin was Administered

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Eileen Fonseca ◽  
David R Walker ◽  
Gregory P Hess
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Sensitivity Analysis ◽  
Propensity Score ◽  
Dabigatran Etexilate ◽  
Admission Rate ◽  
Nonvalvular Atrial Fibrillation ◽  
Treatment Naïve ◽  
Previously Treated Patients ◽  
Previously Treated

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants (OAC) that reduce stroke risk among patients with nonvalvular atrial fibrillation (AF). However, DE does not require titration and INR monitoring. This study examined whether emergency department (ED) rate of admissions differed between the two therapies. Methods: Admission rate was evaluated for hospital encounters initiated in the ED, with a primary or secondary discharge diagnosis of AF between 1/1/2011-3/31/2012, with DE or warfarin administered during the encounter, and excluding encounters of valvular AF patients. Encounters were identified from a hospital Charge Detail Masters database containing 387 eligible hospitals. Samples were propensity score matched using nearest neighbor within a caliper of 0.20 standard deviations of the logit, without replacement, and a 2:1 match. Admission rates were estimated for encounters representing previously-treated patients and those representing treatment-naive patients using binominal generalized linear models, fitted by generalized estimating equations (clustered by hospital). Covariates estimating the propensity score and admission rate included age, payer type, use of bridging agents, AF as primary or secondary diagnosis, CHADS 2 and HAS-BLED scores, comorbid conditions, and hospital attributes. As a sensitivity analysis, admission rate was also estimated from the unmatched sample. Results: Matched samples included 2,688 warfarin and 1,344 DE ED encounters of previously-treated patients out of 15,053 and 1,367 ED encounters, respectively; and 2,578 warfarin and 1,289 DE ED encounters of OAC-treatment-naive patients out of 8,361 and 1,406 ED encounters, respectively. There were too few (n<5) matched encounters where the patient had prior OAC use but were new to the drug administered during the encounter, so these were excluded. No covariates used in matching had standardized mean differences > 10% after matching. Among the previously-treated sample, the estimated admission rate was 3.2% lower for DE compared to warfarin (88.3% vs. 91.5%, p=0.010) with sensitivity analysis confirming a lower admission rate for DE (91.1% vs. 93.8%, delta=2.7%, p=0.001). Among the treatment-naive sample, DE had a 1.2% lower admission rate compared to warfarin (95.2% vs. 96.3%, p=0.048). Sensitivity analysis confirmed a lower admission rate for DE (95.5% vs. 97.0%, delta=1.5%, p=0.001). Conclusions: While the vast majority of AF encounters initiated in the ED result in admission, encounters where patients were treated with DE as continuing or new therapy were less likely to be admitted compared to similar encounters where warfarin was administered.

scholarly journals Comparison of Oral Anticoagulants for Stroke Prevention in Nonvalvular Atrial Fibrillation: A Multicriteria Decision Analysis

2017 ◽  
Vol 20 (10) ◽  
pp. 1394-1402 ◽  
Author(s):  
Tommi Tervonen ◽  
Anastasia Ustyugova ◽  
Sumitra Sri Bhashyam ◽  
Gregory Y.H. Lip ◽  
Paolo Verdecchia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Analysis ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Multicriteria Decision Analysis ◽  
Nonvalvular Atrial Fibrillation ◽  
Multicriteria Decision
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