Objective To describe the trend in atrial fibrillation (AF) treatment strategies in newly diagnosed AF patients between 1999 and 2008. Methods The study was a retrospective cohort study of commercial health plans claims data. Newly diagnosed adult AF patients with ≥1 claim for an AF-related intervention within 12 months of diagnosis were identified. Based on initial treatment, patients were classified into pharmacotherapy or nonpharmacotherapy groups. Pharmacotherapy group was subcategorized into rate-control or rhythm-control groups. Linear regression to assess linear trend and multinomial logistic regression to evaluate factors associated with treatment choice were conducted. Results Three thousand ninety-four newly diagnosed AF patients were identified. Eighty percent of these patients were initiated on pharmacotherapy with the majority (84%) receiving rate-control medications only. Relative distribution of the 3 treatment groups remained similar over the study period. However, within the rate-control group, the use of beta blockers increased significantly (P < .001). Treatment with nonpharmacotherapy over rate-control medications was higher in males but lower in patients aged ≥80 (relative risk ratio [RRR]: 1.67, 95% confidence interval [CI]: 1.27–2.20 and RRR: 0.48, 95% CI: 0.30–0.77, respectively). Having stroke and congestive heart failure significantly affected the treatment choice between nonpharmacotherapy and rate-control medications. Conclusion Medication therapy, especially rate-control strategies, remains the preferred initial therapy of choice.

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physicians and 55% for residents physicians. Similarly the accuracy was higher in the ambulatory setting than for inpatient, 89% vs. 62%. The yield for the HTN group was also higher with attendings than residents, 100% vs. 67%, and the yield was higher in ambulatory versus inpatient settings, 87% vs. 64%. CONCLUSIONS: CDS based on medication orders during CPOE may improve problem lists. The accuracy and yield of diagnostic information is sensitive to medication type, clinical venue and possibly clinician type. Mandatory indication based prescribing may not produce very accurate indication data. There is a substantial need for further research in this area.OBJECTIVES: Treatment strategies for atrial fibrillation (AF) are classified into rate control and rhythm control. They can be employed through the use of pharmacological and non-pharmacological approaches. This study described the trend in the utilization of treatment strategies for the management of AF in newly diagnosed patients between 1999 and 2008. METHODS: The study was a retrospective cohort study of administrative claims data from a large nationally dispersed group of commercially insured subjects from 1999-2008. Newly diagnosed AF patients aged Ն18 years and with at least one claim for an AF related intervention within 12 months of diagnosis were identified. Based on initial treatment received, patients were classified in pharmacotherapy or non-pharmacotherapy treatment groups. Patients initiated on drug-therapies were classified into rate-control (beta-blocker, calcium channel blocker or digoxin) or rhythm control groups. Descriptive analysis was conducted to compare the patient demographic characteristics across the treatment groups. OLS regression was conducted to assess linear trends. RESULTS: Of the 6284 newly diagnosed AF patients who received treatment within one-year, 83.7% underwent pharmacotherapy as the 1 st line therapy. Majority (86.3%) of patients who initiated drug therapy received rate-control medications only. Relative distribution of different treatments across time did not vary significantly. However, within rate-control group, beta-blockers use increased significantly (p Ͻ0.0001) from 47.5% (1999) to 70.58% (2008), whereas use of calcium channel blockers and digoxin decreased. Non-pharmacotherapy was employed more commonly in the mid-west (44.95%, p Ͻ0.0002), in patients younger than 65 years (58.35%, p Ͻ0.0001) and its use decreased with increasing age. Males were more likely to undergo non-pharmacotherapy (69.9%, p Ͻ0.0001). CONCLUSIONS: Higher utilization of rate control as 1 st line therapy compared to other treatment strategies is consistent with the current literature. Greater use of non-pharmacotherapy in younger patients can be partially explained by the higher success rate in this population.

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Purpose: Limited information is available on antipsychotic polypharmacy and associated metabolic adverse events in a pediatric population. This study sought to determine the risk of metabolic adverse events associated with antipsychotic polypharmacy compared to antipsychotic monotherapy use among commercially insured pediatric antipsychotic users.Methods: This was a retrospective cohort study of commercial health plans claims data. New users of antipsychotic medication(s) aged 1-17 years on the date of the first antipsychotic prescription were selected and followed for up to one year after antipsychotic initiation. Patients with preexisting metabolic conditions were excluded. Antipsychotic polypharmacy was defined as concurrent use of two or more chemically distinctive antipsychotic agents. Metabolic adverse events were captured using diagnosis or medication use during the one-year post-index period. Survival analyses using Cox regression models with time-varying exposure variables (any antipsychotic use, antipsychotic dose, antipsychotic exposure-dose combination and antipsychotic type) were conducted adjusting for baseline patient demographic and clinical characteristics. Results:The study included 3,038 pediatric patients with antipsychotic use and 11.06% of them received antipsychotic polypharmacy during the one-year follow-up period. Compared to monotherapy, no statistically significant effect of antipsychotic polypharmacy was found for metabolic adverse events However, high total daily dose of antipsychotics was found to be significantly associated with metabolic adverse events (HR: 2.42 CI: 1.35-4.32). Conclusion:Although no clear increase in risk of metabolic adverse events were detected for antipsychotic polypharmacy use compared to monotherapy, high daily dose of total antipsychotic use was associated with elevated risk for metabolic adverse events in pediatric patients.