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Open Access Research article

Anticoagulant use for the prevention of stroke in patients with atrial fibrillation: findings from a multi-payer analysis

Kathleen Lang1, Duygu Bozkaya1, Aarti A Patel2, Brian Macomson2, Winnie Nelson2, Gary Owens3, Samir Mody2, Jeff Schein2 and Joseph Menzin1*

Author Affiliations

1 Boston Health Economics, Inc, Waltham, MA, USA

2 Janssen Scientific Affairs, LLC, Raritan, NJ, USA

3 Gary Owens Associates Inc, Ocean View, DE, USA

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BMC Health Services Research 2014, 14:329  doi:10.1186/1472-6963-14-329

Published: 28 July 2014

Abstract

Background

Oral anticoagulation is recommended for stroke prevention in intermediate/high stroke risk atrial fibrillation (AF) patients. The objective of this study was to demonstrate the usefulness of analytic software tools for descriptive analyses of disease management in atrial AF; a secondary objective is to demonstrate patterns of potential anticoagulant undertreatment in AF.

Methods

Retrospective data analyses were performed using the Anticoagulant Quality Improvement Analyzer (AQuIA), a software tool designed to analyze health plan data. Two-year data from five databases were analyzed: IMS LifeLink (IMS), MarketScan Commercial (MarketScanCommercial), MarketScan Medicare Supplemental (MarketScanMedicare), Clinformatics™ DataMart, a product of OptumInsight Life Sciences (Optum), and a Medicaid Database (Medicaid). Included patients were ≥ 18 years old with a new or existing diagnosis of AF. The first observed AF diagnosis constituted the index date, with patient outcomes assessed over a one year period. Key study measures included stroke risk level, anticoagulant use, and frequency of International Normalized Ratio (INR) monitoring.

Results

High stroke risk (CHADS2 ≥ 2 points) was estimated in 54% (IMS), 22% (MarketScanCommercial), 64% (MarketscanMedicare), 42% (Optum) and 62% (Medicaid) of the total eligible population. Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively. Among patients at high risk for stroke, 19% to 51% received any anticoagulant.

Conclusions

The AQuIA provided a consistent platform for analysis across multiple AF populations with varying baseline characteristics. Analyzer results show that many high-risk AF patients in selected commercial, Medicare-eligible, and Medicaid populations do not receive appropriate thromboprophylaxis, as recommended by treatment guidelines.

Keywords:
Anticoagulant; Stroke; Prevention; Atrial fibrillation; Warfarin