Impact of Hospitalization and Medication Switching on Post‐discharge Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation

Abstract

BACKGROUND Adherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post-discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation. The aim of this study was to examine the impact of hospitalization and medication switching on post-discharge adherence to OACs in the population with atrial fibrillation. METHODS A quasi-experimental pre-post observational study was conducted using United States commercial insurance health care claims from the 2009 to 2016 Optum database. Adults with atrial fibrillation taking OACs who had a random hospitalization occurring after the first observed OAC prescription fill and no other admission in the preceding and following 6 months were identified. OAC adherence was estimated by the proportion of days covered within 6 and 12 months before and after hospitalization. Difference-indifference analysis was employed to compare the pre-hospitalization and post-hospitalization proportion of days covered, stratified by reasons for hospitalization (i.e., bleeding vs non-bleeding-related reasons) and adjusting for imbalanced baseline characteristics between groups. Change in adherence when the OAC was switched at discharge was also examined. RESULTS The 22,429 individuals who met study criteria were predominantly male (52.4%), white (77.2%), and older age (median 74 years). A clinically significant hemorrhage was the reason for 1029 (4.5%) of qualifying hospitalizations. After covariate adjustment, there was a reduction in the Conflict of interest: Dr. Leonard serves on the executive committee of and Dr. Hennessy directs the University of Pennsylvania's Center for Pharmacoepidemiology Research and Training. The center receives unrestricted educational funding from Pfizer and Sanofi. Dr. Hennessy also consulted for Janssen Research & Development LLC, Daiichi Sankyo Inc, and Mallinckrodt Pharmaceutical and receives salary support from a sponsored research agreement between Pfizer Inc. and the University of Pennsylvania, all unrelated to the topic of this paper. All other authors declared no competing interests for this work.

Direct Oral Anticoagulants versus Vitamin K Antagonists for Patients with Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

“…Although the rate of life-threatening bleeding events was quite low with various anticoagulant agents [5][6][7]9], there is still an increasing need for greater reduction in major bleeding events, because oral anticoagulants are frequently prescribed in combination with antiplatelet agents for LVT patients with complex etiologies, which inevitably and substantially increases the bleeding risk [1,3,4]. In case of any bleeding events, despite the neutral pooled effects, DOACs still showed lower bleeding rates during long-term follow-ups and in patients taking antiplatelet medications, which could be beneficial for improving the quality of life and adherence of patients in need of longterm anticoagulation or antiplatelet treatments [33,34]. Another issue to be noticed is the impact of comorbidities.…”

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“…Although the life-threatening bleeding rate is quite low for various anticoagulant agents 5-9 , there is still increasing need for greater reduction of major bleedings, as oral anticoagulants are frequently prescribed to LVT patients on top of antiplatelet agents due to complex etiologies and background diseases 1,3,4 , which inevitably and substantially increases the actual bleeding risk. For any bleedings, despite the neutral pooled effects, NOACs still achieved lower bleeding rates for longer follow-up and patients taking antiplatelet medications, which is beneficial for improving life quality and adherence of patients in need of long-term anticoagulation or antiplatelet treatments 33,34 . Taken together, NOACs still possessed a better safety profile than VKAs, as it effectively reduced clinically important bleeding events, and showed a potential to reduce overall bleeding rates in patients taking longer and more intensified antithrombotic treatment.…”

Low continuation of antipsychotic therapy in Parkinson disease – intolerance, ineffectiveness, or inertia?

“…To examine overall continuation of AP therapy, we identified all AP prescription fills occurring up to 6 months after AP initiation using pharmacy claims dates in Optum. Time to discontinuation of AP treatment was calculated from the initial AP prescription claim date until the end date for the last AP prescription using prescriptions' days supply, and allowing a standard 14-day grace period (i.e., prescription fill gap) between AP prescription fills [ 29 , 38 – 40 ] to account for potential late refills. Individuals with no additional AP medication fill after the end of this grace period were categorized as discontinuing AP therapy.…”