Outcomes in atrial fibrillation patients on combined warfarin & antiarrhythmic therapy

Science Direct: Annie Guérina, Jay Linb,  Mehul Jhaveric,  Eric Q. Wua, Andrew P. Yua,  Martin Cloutiera, Genevieve Gauthiera, Joseph S. Alpertd – February 13, 2012.

Abstract

Background

This retrospective cohort study compared rates of treatment persistence, incidences of de novo stroke, arterial embolism, and hemorrhage/bleeding, and healthcare resource use and costs between atrial fibrillation/flutter (AF/AFL) patients receiving concomitant warfarin (W) + amiodarone (A) or warfarin + other antiarrhythmic drug (OAAD) therapy in real-world practice.

Methods

The Ingenix IMPACT database (1997–2009) was used to identify patients with ≥ 1 diagnostic claim for AF/AFL and concurrent pharmacy claims (≥ 60 days’ supply) for W and A (n = 4238) or W + OAAD (n = 6332) within the first 90 days of initiating therapy. Outcomes of interest were assessed over 12 months following initiation of dual therapy.

Results

The W + A cohort was older than the W + OAAD cohort (mean 66.5 vs. 61.9 years) and had greater baseline comorbidity. The W + A cohort had significantly 1) lower rates of treatment persistence; 2) higher incidences of de novo stroke (hazard ratio [HR] 1.24), arterial embolism (HR 1.48) and combined stroke/hemorrhage/bleeding/arterial embolism (HR 1.25); 3) more frequent inpatient (incidence rate ratio [IRR] 1.25), emergency room (IRR 1.16) and outpatient (IRR 1.07) admissions; and 4) higher incidences of cardiovascular- (IRR 1.35) and arterial embolism- (IRR 1.94) related healthcare use than the W + OAAD cohort. Incremental total healthcare costs over 12 months were $4114 ($2397 inpatient; $1171 outpatient).Read More