Impact of the Health Insurance Coverage Policy on Oral Anticoagulant Prescription among Patients with Atrial Fibrillation in Korea from 2014 to 2016

Ko, Young Jin; Kim, Seonji; Park, Kyounghoon; Kim, Minsuk; Yang, Bo; Kim, Mi Sook; Lee, Joongyub; Park, Byung Joo

doi:10.3346/jkms.2018.33.e163

Cited by 23 publications

(11 citation statements)

References 22 publications

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“…The prescription of NOACs has increased, and use of VKAs has dropped significantly in many countries [21][22][23], and a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy, potentially driven by the availability of NOACs, was also observed [24][25][26][27]. But in the period that was covered by our study (and it is also the case now) all NOACs in Poland were [28]. The similar situation is in the Canadian universal healthcare system, that covers the cost of NOACs for select patient groups.…”

Section: Discussionsupporting

confidence: 52%

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Wojszel

Kasiukiewicz

2019

J Thromb Thrombolysis

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Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient's frailty status and anemia diagnosis.

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Section: Discussionsupporting

confidence: 52%

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Wojszel

Kasiukiewicz

2019

J Thromb Thrombolysis

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“…Nevertheless, understanding of this special population which is patients with AF unsuitable for warfarin is still important. Because a large proportion of patients with atrial fibrillation (AF) had still received warfarin (44.2% in 2016 in Korea) in the DOAC era, significant number of patients are expected to get warfarin [17]. As time goes by, these warfarin users could become unsuitable for warfarin (e.g., poor INR control, severe kidney/liver disease, severe hypertension).…”

Section: Discussionmentioning

confidence: 99%

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

et al. 2019

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Objective In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for warfarin. Methods We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR). Results The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively ( P = 0.075). Conclusions Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs.

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“…In Korea, the proportion of patients with anticoagulation was low. However, it significantly increased after change in health insurance coverage policy for new oral anticoagulants in July 2015 [ 30 ]. A large-scale prospective study is needed to elucidate medical interventions including effects of new oral anticoagulants for carotid atherosclerosis in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Impact of carotid atherosclerosis in CHA2DS2-VASc-based risk score on predicting ischemic stroke in patients with atrial fibrillation

Cho

Choi

et al. 2021

Korean J Intern Med

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Background/Aims: Vascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA 2 DS 2 -VASc score. However, the role of carotid atherosclerosis remains to be determined. Methods: Three hundred-ten patients with AF who underwent carotid sonography were enrolled. Results: During a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA 2 DS 2 -VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e'), a ratio of early transmitral flow velocity to e' (E/e') and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA 2 DS 2 -VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013). Conclusions: Increased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA 2 DS 2 -VASc scoring system.

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Impact of the Health Insurance Coverage Policy on Oral Anticoagulant Prescription among Patients with Atrial Fibrillation in Korea from 2014 to 2016

Cited by 23 publications

References 22 publications

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65

Impact of carotid atherosclerosis in CHA2DS2-VASc-based risk score on predicting ischemic stroke in patients with atrial fibrillation

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