Does hospitalization for thromboembolism improve oral anticoagulant adherence in patients with atrial fibrillation?
Journal
Journal of the American Pharmacists Association : JAPhA
ISSN: 1544-3450
Titre abrégé: J Am Pharm Assoc (2003)
Pays: United States
ID NLM: 101176252
Informations de publication
Date de publication:
Historique:
received:
25
05
2020
revised:
21
07
2020
accepted:
03
08
2020
pubmed:
5
9
2020
medline:
29
6
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
It is not known how medication adherence changes after hospitalization for a sentinel thromboembolic event. The purpose of this study was to examine the impact of hospitalization for ischemic stroke or thromboembolism on postdischarge adherence to oral anticoagulants in patients with atrial fibrillation. We conducted a quasi-experimental pre-post observational study using a large U.S. commercial insurance health care claims database. Adult patients with atrial fibrillation taking oral anticoagulants with a random hospitalization for a nonbleeding-related reason occurring after the first observed oral anticoagulant prescription fill, with no other admissions within the preceding and following 6 months, were identified in Optum Clinformatics (Eden Prairie, MN) from 2009 to 2016. Adherence was estimated by the proportion of days covered within 6 and 12 months before and after hospitalization. Difference-in-difference analysis using a generalized linear model was employed to compare pre- and post-hospitalization proportions of days covered (PDCs) by reasons for hospitalization (i.e., ischemic stroke or thromboembolism vs. other nonbleeding-related reasons), adjusting for imbalanced baseline characteristics. Of the 21,400 individuals meeting inclusion criteria, 5.4% were hospitalized for ischemic stroke or thromboembolism and 94.6% for other nonbleeding-related reasons. Baseline characteristics were quite similar between groups, except for a few covariables such as age or CHA This real-world study suggests that more effective strategies are needed to improve adherence to oral anticoagulant, particularly after a thromboembolic event.
Sections du résumé
BACKGROUND
It is not known how medication adherence changes after hospitalization for a sentinel thromboembolic event.
OBJECTIVE
The purpose of this study was to examine the impact of hospitalization for ischemic stroke or thromboembolism on postdischarge adherence to oral anticoagulants in patients with atrial fibrillation.
METHODS
We conducted a quasi-experimental pre-post observational study using a large U.S. commercial insurance health care claims database. Adult patients with atrial fibrillation taking oral anticoagulants with a random hospitalization for a nonbleeding-related reason occurring after the first observed oral anticoagulant prescription fill, with no other admissions within the preceding and following 6 months, were identified in Optum Clinformatics (Eden Prairie, MN) from 2009 to 2016. Adherence was estimated by the proportion of days covered within 6 and 12 months before and after hospitalization. Difference-in-difference analysis using a generalized linear model was employed to compare pre- and post-hospitalization proportions of days covered (PDCs) by reasons for hospitalization (i.e., ischemic stroke or thromboembolism vs. other nonbleeding-related reasons), adjusting for imbalanced baseline characteristics.
RESULTS
Of the 21,400 individuals meeting inclusion criteria, 5.4% were hospitalized for ischemic stroke or thromboembolism and 94.6% for other nonbleeding-related reasons. Baseline characteristics were quite similar between groups, except for a few covariables such as age or CHA
CONCLUSION
This real-world study suggests that more effective strategies are needed to improve adherence to oral anticoagulant, particularly after a thromboembolic event.
Identifiants
pubmed: 32883621
pii: S1544-3191(20)30390-3
doi: 10.1016/j.japh.2020.08.004
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
986-992.e2Informations de copyright
Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.