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Outcomes in atrial fibrillation patients on combined warfarin & antiarrhythmic therapy.
MedLine Citation:
PMID:  22336254     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 ≥1 diagnostic claim for AF/AFL and concurrent pharmacy claims (≥60days' supply) for W and A (n=4238) or W+OAAD (n=6332) within the first 90days of initiating therapy. Outcomes of interest were assessed over 12months following initiation of dual therapy. RESULTS: The W+A cohort was older than the W+OAAD cohort (mean 66.5 vs. 61.9years) 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 12months 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.
Authors:
Annie Guérin; Jay Lin; Mehul Jhaveri; Eric Q Wu; Andrew P Yu; Martin Cloutier; Genevieve Gauthier; Joseph S Alpert
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-13
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Analysis Group Inc., Boston, Massachusetts, USA.
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