Outcomes in atrial fibrillation patients on combined warfarin & antiarrhythmic therapy

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• 作者：Annie Gu&eacute ; rin^a ; ^{aguerin@analysisgroup.com} ; Jay Lin^b ; Mehul Jhaveri^c ; Eric Q. Wu^a ; Andrew P. Yu^a ; Martin Cloutier^a ; Genevieve Gauthier^a ; Joseph S. Alpert^d
• 关键词：Antiarrhythmic drug ; Warfarin ; Atrial fibrillation ; Amiodarone ; Cost
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：31 July, 2013
• 年：2013
• 卷：167
• 期：2
• 页码：564-569
• 全文大小：547 K

文摘

Background

This retrospective cohort study compared rates of treatment persistence, incidences of de novo stroke, arterial embolism, and hemorrhage/bleeding, and healthcare resource use and costs between atrial fibrillation/flutter (AF/AFL) patients receiving concomitant warfarin (W) + amiodarone (A) or warfarin + other antiarrhythmic drug (OAAD) therapy in real-world practice.

Methods

The Ingenix IMPACT database (1997-2009) was used to identify patients with ¡Ý 1 diagnostic claim for AF/AFL and concurrent pharmacy claims (¡Ý 60 days' supply) for W and A (n = 4238) or W + OAAD (n = 6332) within the first 90 days of initiating therapy. Outcomes of interest were assessed over 12 months following initiation of dual therapy.

Results

The W + A cohort was older than the W + OAAD cohort (mean 66.5 vs. 61.9 years) and had greater baseline comorbidity. The W + A cohort had significantly 1) lower rates of treatment persistence; 2) higher incidences of de novo stroke (hazard ratio [HR] 1.24), arterial embolism (HR 1.48) and combined stroke/hemorrhage/bleeding/arterial embolism (HR 1.25); 3) more frequent inpatient (incidence rate ratio [IRR] 1.25), emergency room (IRR 1.16) and outpatient (IRR 1.07) admissions; and 4) higher incidences of cardiovascular- (IRR 1.35) and arterial embolism- (IRR 1.94) related healthcare use than the W + OAAD cohort. Incremental total healthcare costs over 12 months were $4114 ($2397 inpatient; $1171 outpatient).

Conclusions

Allowing for differences in prescribing practice, AF/AFL patients treated with W + A are at higher risk of stroke and arterial embolism, and have higher healthcare use and costs, than patients receiving W + OAAD.