Cardiovascular Disease |

Treatment and Discharge Patterns Among Patients Hospitalized With Nonvalvular Atrial Fibrillation (NVAF) Who Transition From the Inpatient to Outpatient Setting FREE TO VIEW

Jeffrey Trocio; Amanda Bruno; Kenneth Tuell; Kwanza Price; Prianka Singh; Jack Mardekian; Kevin Odell; Chad Patel; Wilson Tan; Henry Henk; Lien Vo
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Optum, Eden Prairie, MN

Chest. 2015;148(4_MeetingAbstracts):66A. doi:10.1378/chest.2250462
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SESSION TITLE: Cardiovascular Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Using administrative claims data for commercial and Medicare Advantage enrollees linked to hospital electronic health records (EHR) and social security administration’s (SSA) death master file, we describe the inpatient oral anticoagulant (OAC) treatment, discharge location status, and post-discharge OAC treatment for patients hospitalized with NVAF.

METHODS: We identified 2,932 patients that were hospitalized with a primary (38%) or secondary (62%) diagnosis of AF without evidence of rheumatic mitral valvular heart disease or a valve replacement procedure between 01 Jan 2009 and 30 Sep 2013. Inpatient OAC treatment was identified from the EHR data, while discharge status (deceased, long term care, home health care, and home self-care) and OAC treatment in the 30-days post discharge were obtained from claims data and SSA death master file.

RESULTS: The mean age was 72.5 years, 61.3% were male, 70.6% enrolled in a Medicare Advantage plan, and 51 (1.7%) patients died while hospitalized. Of the 2,932 hospitalized patients, 6.5% received a target-specific OAC (TSOAC) (apixaban, rivaroxaban or dabigatran), 37.5% warfarin, and 56% no OAC. Patients receiving a TSOAC were younger (69.1 years) and more likely to be male (69.0%). Of the surviving patients, 71.4% were discharged to home health-care, 12.7% home self-care, and 5.3% long term care (discharge status was unknown for 10.7%). In the 30-days post discharge, 40% of patients initiated on warfarin therapy in the hospital filled a warfarin prescription in the retail setting whereas 52% of patients initiated on a TSOAC prescription in the hospital filled a TSOAC prescription. Very few patients in either cohort filled an outpatient prescription for a different medication; however 19% of NVAF patients who were not initiated on an OAC during their hospitalization did fill a prescription for warfarin (17.6%) or a TSOAC (1.8%) in the first 30 days post discharge.

CONCLUSIONS: The majority of patients hospitalized for NVAF were discharged to home with home health support and a large proportion received no OAC treatment during their hospitalization or in the 30-days post-discharge. More patients initiated on a TSOAC while hospitalized filled a prescription in the first 30 days than patients initiated on warfarin. Additional investigation should be conducted into whether these trends persist beyond 30 days.

CLINICAL IMPLICATIONS: Implications of these treatment patterns on real-world outcomes will require further evaluation.

DISCLOSURE: Jeffrey Trocio: Employee: Employee of Pfizer, a sponsor of this research. Amanda Bruno: Employee: Employee BMS Kenneth Tuell; Employee: Employee BMS Kwanza Price: Employee: Employee Pfizer Prianka Singh: Employee: Employee BMS Jack Mardekian: Employee: Employee Pfizer Kevin Odell: Employee: Employee Pfizer Chad Patel: Employee: Employee BMS Wilson Tan: Employee: Employee Pfizer Henry Henk: Consultant fee, speaker bureau, advisory committee, etc.: Henry Henk is an employee of Optum, a consulting firm retained to conduct research on which this submission is based. Lien Vo: Employee: Employee BMS

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