Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States.

IF 2.4 Journal of Drug Assessment Pub Date : 2020-04-24 eCollection Date: 2020-01-01 DOI:10.1080/21556660.2020.1750418
Steven Deitelzweig, Christine L Baker, Amol D Dhamane, Jack Mardekian, Oluwaseyi Dina, Lisa Rosenblatt, Cristina Russ, Tayla Poretta, Melissa Lingohr-Smith, Jay Lin
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引用次数: 2

Abstract

Objectives: To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods: Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013-30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. Results: NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02-1.08; p < .001), MB-related (OR: 1.28; CI: 1.16-1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11-1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02-1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44-1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion: In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.

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美国口服抗凝剂治疗的住院非瓣膜性房颤患者再入院率的比较
目的:比较先前因非瓣膜性房颤(NVAF)住院并接受华法林、利伐沙班和达比加群与阿哌沙班治疗的患者1个月全因、大出血(MB)相关和卒中相关再入院的风险以及相关的医院资源使用和费用。方法:从Premier数据库(2013年1月1日- 2017年6月30日)中确定住院期间接受阿哌沙班、华法林、利伐沙班或达比加群治疗的非瓣膜性房颤动(任何出院诊断位置)的成年患者,并将其分组到各自的队列中。倾向评分匹配用于生成具有相似特征的队列。在回归分析中,评估出院后1个月内再入院的风险,并比较相关的住院时间(LOS)和费用。结果:华法林与阿哌沙班治疗的非瓣膜性房颤患者的全因风险显著高于阿哌沙班(优势比[OR] = 1.05;置信区间[CI] = 1.02-1.08;P P = .002)再入院;在所有再入院类别中,华法林治疗患者的平均住院时间明显更长,费用明显更高。利伐沙班与阿哌沙班治疗的非瓣膜性房颤患者的全因风险显著高于阿哌沙班(OR: 1.06;置信区间:1.02—-1.09;p = .001)和mb相关(OR = 1.62;Ci = 1.44-1.83;结论:在对非瓣膜性房颤患者的回顾性分析中,阿哌沙班治疗的临床结果优于华法林或利伐沙班,且医院资源负担更低。
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Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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