Oral anticoagulation use by patients with atrial fibrillation in Germany

Thomas Wilke; Antje Groth; Sabrina Mueller; Matthias Pfannkuche; Frank Verheyen; Roland Linder; Ulf Maywald; Thomas Kohlmann; You-Shan Feng; Günter Breithardt; Rupert Bauersachs

doi:10.1160/TH11-11-0768

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2012; 107(06): 1053-1065
DOI: 10.1160/TH11-11-0768

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Oral anticoagulation use by patients with atrial fibrillation in Germany

Adherence to guidelines, causes of anticoagulation under-use and its clinical outcomes, based on claims-data of 183,448 patients

Thomas Wilke

¹Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany

,

Antje Groth

¹Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany

,

Sabrina Mueller

¹Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany

,

Matthias Pfannkuche

²Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany

,

Frank Verheyen

³Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG), Techniker Krankenkasse, Hamburg, Germany

,

Roland Linder

³Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG), Techniker Krankenkasse, Hamburg, Germany

,

Ulf Maywald

⁴AOK Plus, Dresden, Germany

,

Thomas Kohlmann

⁵Institut für Community Medicine, Abteilung Methoden, Universität Greifswald, Germany

,

You-Shan Feng

⁵Institut für Community Medicine, Abteilung Methoden, Universität Greifswald, Germany

,

Günter Breithardt

⁶Department of Cardiology and Angiology, Universität Münster, Germany

,

Rupert Bauersachs

⁷Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany

› Institutsangaben

Abstract

Summary

Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder. Oral anticoagulation (OAC) is recommended by guidelines in the presence of a moderate to high risk of stroke. Based on an analysis of claims-based data, the aim of this contribution is to quantify the stroke-risk dependent OAC utilisation profile of German AF patients as well as the possible causes and the associated clinical outcomes of OAC under-use. Our data set was derived from two large mandatory German medical insurance funds. Risk stratification of patients was based on the CHADS2-score and the CHA2DS2-VASc-score. Two different scenarios were constructed to deal with factors potentially disfavouring OAC use. Causes of OAC under-use and its clinical consequences were analysed using multivariate analysis. Observation year was 2008. A total of 183,448 AF patients met the inclusion criteria. This represents an AF prevalence of 2.21%. The average CHADS2-score was 2.8 (CHA2DS2-VASc-score: 4.3). On between 40.5 and 48.7% of the observed patient-days, there was no antithrombotic protection by OAC, other anticoagulants or aspirin. Older female patients with a high number of comorbidities had a higher risk of OAC under-use. Patients who had already experienced a thromboembolic event had a lower risk of OAC under-use. In the observation year, 3,367 patients experienced a stroke (incidence rate 1.8%). In our multi-level Poisson random effects estimate, OAC use decreases the stroke rate by almost 80% (IRR 0.236). In conclusion, OAC under-use is widespread in the German market. It is associated with severe clinical consequences.

Keywords

Vitamin K-dependent factors - antiplatelet agents - management of disease

Volltext

Referenzen

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