Background/Introduction The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Purpose The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS). Methods The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient. Results Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p<0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively). Conclusion This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain. Funding Acknowledgement Type of funding sources: None.
S79ObjectiveS: To identify the effects of using extended-release (XR) medications on adherence, HbA1C control and diabetes-related hospitalizations among patients prescribing oral antidiabetic agents. MethOdS: Using a commercial claims database, we identified 29,969 patients, who prescribed either XR or non-XR formulations of Metformin or Glipizide, for at least a year from 2011 to 2012. We measured adherence from first fill till 12/31/2012, changes in HbA1C before and in 2013, and count of diabetes-related hospital admissions in 2013. We first used multivariate regressions to model the relationship between XR formulation and adherence, changes in HbA1C and count of hospital admissions, controlling for patients' sociodemographic characteristics and comorbidities. To address self-selection into XR formulations, we built a two-stage endogenous binary variable model (EBVM), which first modeled patients' formulation choice. Our plausibly exogenous instrumental variable for XR use was the relative out-of-pocket cost of XR versus non-XR medications in each insurance plan in 2011 and 2012. ReSultS: After adjustment, patients prescribing XR formulations had improved adherence (78.4% vs. 75.8%, P < 0.01) and a lower count of hospital admissions in 2013 (0.054 vs. 0.068 per person, p < 0.01). XR users had larger decreases in HbA1C than Non-XR users (-0.10% vs. -0.17%), though statistically insignificant. Our EBVM model indicates that if all patients were using XR formulations in our sample, adherence would improve by 5.1% (81.6% vs. 76.5%, p < 0.01), the annual count of diabetes-related hospitalization decrease by 50% (0.032 vs. 0.063, p < 0.01), and HbA1C would decrease by 1.50% more (-1.66% vs. -0.15%, p < 0.01). Based on the model predictions and costs from claims, on an individual level, using XR formulations incurred an additional annual cost of $33.55, but saved $470.08 through reduced hospitalizations. cOncluSiOnS: Extended-release medications improve patients' adherence, lowers HbA1c, and reduces diabetes-related hospitalizations. Extendedrelease medications can generate significant social value.
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