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Non-persistence to Oral Anticoagulation Treatment in Patients with Non-valvular Atrial Fibrillation in the USA
ConclusionIn over one million patients with NVAF, our results suggest differences in anticoagulation treatment persistence across OAC agents, even after accounting for clinical events after OAC initiation. It is important for clinicians and patients to take these differences into consideration, especially as non-persistence to OAC therapy is associated with thromboembolic complications.
Source: American Journal of Cardiovascular Drugs - October 21, 2021 Category: Cardiology Source Type: research

Who Should Be Referred for Left Atrial Appendage Occlusion Therapy?
Opinion statementAtrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 7 million individuals in USA. It is one of the most significant arrhythmias, which accounts for a majority of embolic strokes, especially in elderly individuals. Although oral anti-coagulation is beneficial in lowering the risk of stroke, 1 in 10 patients have a contra-indication to warfarin therapy. Among patients who do tolerate either warfarin or novel oral anticoagulant (NOAC), major or recurrent bleeding, intracranial bleeds, etc. often lead to interruption of anti-coagulation. Previous studies have reported that>...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2017 Category: Cardiology Source Type: research

Stroke Risk Reduction Outweighed Bleeding Risk Increase from Vitamin K Antagonists Treatment among Nonvalvular Atrial Fibrillation Patients with High Stroke risk and Low Bleeding Risk.
CONCLUSION: In NVAF patients at high risk for stroke and low risk for bleeding, our data confirm the effectiveness of anticoagulation for stroke prevention. The decrease in stroke risk of anticoagulation may outweigh the risk of major bleeding events, particularly among elderly patients. Potential risks of warfarin during initiation warrant attention, especially among patients who stop and start therapy repeatedly. PMID: 28008771 [PubMed - as supplied by publisher]
Source: Current Medical Research and Opinion - December 25, 2016 Category: Research Tags: Curr Med Res Opin Source Type: research

Prominent cardiologist calls for a halt to Watchman implants
A prominent cardiologist is calling for a stop to left atrial appendage closure procedures using Boston Scientific‘s (NYSE:BSX) Watchman device, claiming the procedures, which seek to reduce stroke in patients with nonvalvular atrial fibrillation, result in the opposite. Dr. John Mandrola argues that randomized, controlled trials of the Watchman, designed for LAA closure, showed the device failed to reduce ischemic stroke, despite being designed for just that purpose. “Yet we look away; or we let advocates distract us with complicated statistics,” Dr. Mandrola wrote in an article on Medscape. “Iâ€...
Source: Mass Device - November 10, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Cardiovascular Boston Scientific Source Type: news

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
Conclusions In a contemporary AF cohort, use of OAC overall and use of NOACs were not significantly lower among Medicaid patients relative to others. However, among warfarin users, Medicaid patients spent less time in therapeutic range compared with those with other forms of insurance.
Source: JAHA:Journal of the American Heart Association - May 3, 2016 Category: Cardiology Authors: O'Brien, E. C., Kim, S., Thomas, L., Fonarow, G. C., Kowey, P. R., Mahaffey, K. W., Gersh, B. J., Piccini, J. P., Peterson, E. D. Tags: Atrial Fibrillation, Primary Prevention, Health Services, Quality and Outcomes Health Services and Outcomes Research Source Type: research

Study: Boston Scientific’s Watchman cheaper than drugs in reducing afib stroke risk
A study comparing the stroke risk for atrial fibrillation patients treated with Boston Scientific‘s (NYSE:BSX) Watchman device with the anticoagulant drug warfarin and non-warfarin oral anticoagulants found Watchman to be more cost-effective than its counterparts. Watchman is a catheter-delivered cardiac implant designed to close off the left atrial appendage, to prevent blood clots from forming there that could later cause a stroke. The study, published online in the Journal of the American College of Cardiology, showed that the Watchman device was cost-effective at 7 years at a cost of $42,994 per quality-adjust...
Source: Mass Device - December 15, 2015 Category: Medical Equipment Authors: Brad Perriello Tags: Wall Street Beat Cardiovascular Cardiac Implants Clinical Trials Boston Scientific Reimbursement Source Type: news

Time to Cost-Effectiveness Following Stroke Reduction Strategies in AF Warfarin Versus NOACs Versus LAA Closure
ConclusionsBoth NOACs and LAAC with the Watchman device were cost-effective relative to warfarin, but LAAC was also found to be cost-effective and to offer better value relative to NOACs. The results of this analysis should be considered when formulating policy and practice guidelines for stroke prevention in AF.
Source: Journal of the American College of Cardiology - December 14, 2015 Category: Cardiology Source Type: research

Boston Scientific dips on Medicare reimbursement hit for Watchman anti-stroke device
Boston Scientific (NYSE:BSX) shares took a hit yesterday after a Centers for Medicare & Medicaid Services proposal that would limit coverage for the Watchman anti-stroke device. Investors also likely reacted to a pair of Class II recalls from the FDA, sending BSX shares down -4.2% to $18.01 apiece yesterday. Watchman, a transcatheter implant designed to seal off the left atrial appendage to prevent the formation of blood clots that could cause stroke, was approved by the FDA in March and asked for a CMS coverage decision in May. The federal health insurer proposed to limit coverage for Watchman to patients in approv...
Source: Mass Device - November 12, 2015 Category: Medical Equipment Authors: Brad Perriello Tags: Cardiac Implants Cardiovascular Recalls Boston Scientific Cardiac Rhythm Management Stroke Source Type: news

Cost effectiveness of left atrial appendage closure versus Warfarin for stroke risk reduction in non-valvular Atrial Fibrillation in CMS patients
Stroke is the most severe and debilitating consequence of atrial fibrillation (AF), with many patients ranking the resultant disability as worse than death. Warfarin, the established first-line therapy, is effective at reducing ischemic stroke, but is associated with increased bleeding risk and lower quality of life (QoL). Left atrial appendage closure (LAAC) with the Watchman Device has been found to be superior to warfarin at reducing risk of stroke in AF patients. This analysis sought to assess the cost effectiveness of LAAC versus warfarin for stroke prevention in non-valvular AF from the perspective of the US Centers ...
Source: Value in Health - May 1, 2015 Category: Global & Universal Authors: V. Reddy, R. Akehurst, S.L. Amorosi, S. Armstrong, S. Beard, C. Knight, C. Taggart, D. Holmes Source Type: research

Abstract 14: Clinical Characteristics and Treatment Patterns of Medicaid Patients with Atrial Fibrillation: Insights From the ORBIT-AF I Registry Session Title: Concurrent Session IIB: Oral Abstracts - Quality of Care
Conclusions: In a contemporary, community-based AF cohort, Medicaid patients had a greater comorbidity burden and higher stroke risk, yet were less likely to receive OAC compared with those with other forms of insurance.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: O'Brien, E. C., Kim, S., Thomas, L., Fonarow, G. C., Mahaffey, K. W., Kowey, P. R., Gersh, B. J., Burton, P. S., Piccini, J. P., Peterson, E. D. Tags: Session Title: Concurrent Session IIB: Oral Abstracts - Quality of Care Source Type: research

National utilization patterns of warfarin use in older patients with atrial fibrillation: a population-based study of Medicare Part D beneficiaries
Source: Annals of Pharmacotherapy Area: Evidence > Medicines Management > References Background: Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low.  In 2008, the US Medicare Part D programme was expanded to pay for medications for Medicare enrollees. Objective: To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. Methods: This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in ...
Source: NeLM - Cardiovascular Medicine - January 24, 2013 Category: Cardiology Source Type: news

National utilization patterns of warfarin use in older patients with atrial fibrillation: a population-based study of medicare part d beneficiaries.
CONCLUSIONS: Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use. PMID: 23324508 [PubMed - in process]
Source: The Annals of Pharmacotherapy - January 1, 2013 Category: Drugs & Pharmacology Authors: Raji MA, Lowery M, Lin YL, Kuo YF, Baillargeon J, Goodwin JS Tags: Ann Pharmacother Source Type: research