Clinical Characteristics, Oral Anticoagulation Patterns, and Outcomes of Medicaid Patients With Atrial Fibrillation: Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I) Registry Health Services and Outcomes Research

Background Whereas insurance status has been previously associated with care patterns, little is currently known about the association between Medicaid insurance and the clinical characteristics, treatment, or outcomes of patients with atrial fibrillation (AF). Methods and Results We used data from adults with AF enrolled in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF), a national outpatient registry conducted at 176 community, multispecialty sites. The primary outcome of interest was the proportion of patients prescribed any oral anticoagulation (OAC; warfarin or novel oral anticoagulants [NOAC]). Secondary outcomes of interest included the proportion of patients prescribed NOACs (dabigatran or rivaroxaban); time in therapeutic range (TTR) for warfarin users, all-cause mortality, stroke/systemic embolism, and major bleed. Of 10 133 patients, N=470 (4.6%) had Medicaid insurance. Medicaid patients were similarly likely to receive OAC at baseline (72.8% vs 76.3%; unadjusted P=0.079), but less likely to receive NOAC at baseline or follow-up (12.1% vs 16.3%; unadjusted P=0.019). After risk adjustment, Medicaid status was associated with lower use of OAC at baseline among patients with high stroke risk (odds ratio [OR]=0.68; 95% CI=0.49, 0.94), but was not associated with OAC use overall (OR=0.82; 95% CI=0.61, 1.09). Among warfarin users, median TTR was lower among Medicaid patients (60% vs 68%; P
Source: JAHA:Journal of the American Heart Association - Category: Cardiology Authors: Tags: Atrial Fibrillation, Primary Prevention, Health Services, Quality and Outcomes Health Services and Outcomes Research Source Type: research

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Nervenarzt. 2021 Oct 15. doi: 10.1007/s00115-021-01206-w. Online ahead of print.ABSTRACTOral anticoagulation in patients with cerebral amyloid angiopathy is a therapeutic challenge. The association of cerebral amyloid angiopathy with intracerebral hemorrhage, a high mortality of intracerebral hemorrhage especially under oral anticoagulation and the high risk of recurrent bleeding require a multidisciplinary approach and a thorough risk-benefit analysis. Vitamin K antagonists increase the risk of intracerebral bleeding and the accompanying mortality by 60% and should be avoided if possible or reserved for special clinical s...
Source: Der Nervenarzt - Category: Neurology Authors: Source Type: research
CONCLUSIONS: In AF patients with severe AIS, early OAC use before the guideline-recommended days appeared to increase the risk of bleeding events, although the OAC initiation time seemed not to affect the risk of serious vascular events. The optimal severity-specific timing for OAC initiation after AIS requires further evaluation.PMID:34649296 | DOI:10.1055/a-1669-4987
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Source Type: research
ConclusionsDabigatran has a favorable impact on effectiveness and safety outcomes compared with vitamin K antagonists in real-world populations.
Source: Clinical Drug Investigation - Category: Drugs & Pharmacology Source Type: research
ConclusionThe benefit-risk profile of NOACs compared to VKAs was preserved in AF patients using P-gp/CYP3A4 inhibitors, including amiodarone.
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
CONCLUSIONS: Rates of nontreatment and undertreatment among NVAF patients remain high and are associated with preventable cardiovascular events and death. Strategies to increase rates of treatment may improve clinical outcomes.PMID:34632887 | DOI:10.1080/03007995.2021.1982684
Source: Current Medical Research and Opinion - Category: Research Authors: Source Type: research
This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database. Results During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiog...
Source: Dimensions of Critical Care Nursing - Category: Nursing Tags: Clinical DIMENSION Source Type: research
Managing anticoagulation therapy in patients with acute coronary syndrome and atrial fibrillation requires effective use of risk stratification scores to optimize treatment options while weighing the risk of stroke or systemic thromboembolism vs the risk of bleeding. A mnemonic-based clinical practice pathway is proposed to provide nurse practitioners with a structured approach to managing patients with atrial fibrillation in the context of an acute coronary syndrome. The AUDITS mnemonic represents a simplified treatment guide derived from current guidelines and aims to help nurse practitioners implement best practices to ...
Source: The Journal for Nurse Practitioners - Category: Nursing Authors: Tags: Featured Article Source Type: research
This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database.RESULTS: During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at ...
Source: Dimensions in Critical Care Nursing - Category: Nursing Authors: Source Type: research
RARITAN, NJ, September 27, 2021 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today new data from the Phase 3 UNIVERSE study showing treatment with XARELTO® (rivaroxaban) in an oral suspension formulation, compared to treatment with aspirin, was associated with numerically fewer blood clots and clinical events strongly associated with blood clots in pediatric patients (aged 2-8 years) who have undergone the Fontan procedure. [1] These findings, which were published this month in the Journal of the American Heart Association and included in a recent New Drug Application submitted to the ...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
J Cardiol. 2021 Sep 23:S0914-5087(21)00234-3. doi: 10.1016/j.jjcc.2021.08.031. Online ahead of print.ABSTRACTAtrial fibrillation (AF) is responsible for cardiogenic stroke. Since left atrial appendage (LAA) is a cause of most of cardiac thrombus, LAA closure is an emerging novel stroke prevention procedure for patients with AF alternative to anticoagulation. WATCHMAN LAA Closure device (Boston Scientific, Marlborough, MA, USA) is the only approved device in the USA and Japan. The device is indicated in high bleeding risk and high stroke risk non-valvular AF patients. Cardiac tamponade, stroke, and device embolization are t...
Source: Journal of Cardiology - Category: Cardiology Authors: Source Type: research
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