Abstract 131: Ranolazine Improves Cardiovascular Outcomes and Healthcare Utilization: A Comparative Effective Analysis with Traditional Antianginal Medications

Abstract

Introduction: Real-world comparative studies evaluating traditional with newer antianginal medications in chronic stable angina (CSA) on cardiovascular (CV) outcomes and healthcare utilization are limited. Methods: Medical and pharmacy claims from 2008-2012 were analyzed using a large commercial database. Patients with a CSA diagnosis receiving ranolazine, beta blocker (BB), calcium channel blocker (CCB), or long-acting nitrates (nitrates) were identified and followed for 12 months after a change in antianginal therapy. Patients on traditional antianginal medication: BB, CCB, and nitrates were required to have concurrent sublingual nitroglycerin. Therapy change was defined as adding or switching to another traditional antianginal or ranolazine to identify patients who had failed prior therapy. Four groups were identified (BB, CCB, nitrates, or ranolazine users) and matched for age,gender, baseline Charlson Comorbidity Index (CCI), acute coronary syndrome,hypertension, diabetes, heart failure, hyperlipidemia, diabetes related complications, and cardiovascular healthcare costs. Rates for percutaneous intervention (PCI) and coronary bypass graft (CABG) at 30, 60, 90, 180 and 360 days, as well as, annual number of CV-related outpatient visits, emergency room (ER) visits, and inpatient admissions post therapy change were compared between groups. Results: A total of 8008 patients were identified with 2002 patients in each antianginal matched group. The majority (63-65%) were male with a mean age of 66 years and a CCI of 2.89-3.01. The Table summarizes the annual rate per 1000 for CV outcomes. Compared to other antianginal therapies, ranolazine consistently exhibited lower PCI and CABG rates at all time periods following therapy change. Compared to BB, CCB,and nitrates,ranolazine had a 21% (p=0.004), 4% (p=0.578), and 23% (p<0.0001) lower mean number of annual CV inpatient admissions; and 15% (p<0.0001), 4% (p=0.224), and 13% (p<0.0001) lower mean number of annual CV outpatient visits,respectively.Ranolazine had a 17-21% lower mean annual number of CV ER visits compared to the other antianginal groups (p=0.073,p=0.079, p=0.106,respectively). Conclusion: Ranolazine improves CV outcomes and lowers healthcare utilization compared to traditional antianginal therapies.