Analyses: High-risk AFib patients not receiving recommended thromboprophylaxis

Widespread anticoagulant undertreatment persists among atrial fibrillation (AFib) patients at high risk of stroke, despite current medical treatment guidelines, which recommend thromboprophylaxis for this patient population unless contraindicated, according to a recent study in BMC Health Services Research.

Retrospective data analyses were performed using the Anticoagulant Quality Improvement Analyzer (AQuIA), a software tool designed to analyze health plan data. Two-year data from 5 databases were analyzed: IMS LifeLink, MarketScan Commercial, MarketScan Medicare Supplemental, ClinformaticsTM DataMart, a product of OptumInsight Life Sciences and a Medicaid Database. Key study measures included stroke risk level, anticoagulant use, and frequency of International Normalized Ratio (INR) monitoring.

High stroke risk (CHADS2 ≥ 2 points) was estimated in 54% (IMS), 22% (MarketScanCommercial), 64% (MarketscanMedicare), 42% (Optum) and 62% (Medicaid) of the total eligible population. Overall, 35%, 29%, 38%, 39% and 16% of all AF patients received an anticoagulant medication in IMS, MarketScanCommercial, MarketScanMedicare, Optum and Medicaid, respectively. At best only 51% of AFib patients at high risk of stroke receive treatment with an anticoagulant, despite current medical treatment guidelines, which recommend thromboprophylaxis for this patient population unless contraindicated.

AFib, the most common clinically significant cardiac rhythm disorder, increases a patient’s risk for stroke up to 5-fold, directly or indirectly contributing to more than $30 billion in annual healthcare costs, lead investigator Winnie Nelson, director, Health Economics & Outcomes Research, at Janssen Pharmaceuticals.

“Appropriate treatment, such as with an oral anticoagulant, has been shown to reduce the annual incidence of stroke in the United States by more than 60%, which may lead to decreased mortality rates and hospital cost savings,” Nelson said.