Abstract:
BACKGROUND:Although atrial fibrillation (AF) occurs frequently in patients hospitalized with acute coronary syndrome (ACS), strategies for prevention of thromboembolic complications are poorly characterized. HYPOTHESIS:We sought to examine exposure to warfarin and P2Y12 inhibitors and clinical outcomes among patients with AF and ACS. METHODS:Patients age >65 years hospitalized with a primary diagnosis of ACS and a secondary diagnosis of AF between 2007 and 2010 were identified in the Medicare 5% sample. Medication exposure was ascertained during a 90-day period following the index discharge using Medicare drug claims. Among patients who were alive and not readmitted during the ascertainment period, we examined the cumulative incidence of all-cause mortality and all-cause readmission by medication exposure at 1 year. RESULTS:A total of 2509 Medicare beneficiaries met the inclusion criteria. Among the 1633 patients (65%) who were alive and not readmitted during the 90-day ascertainment period, 24.0% received warfarin, 38.9% received P2Y12 inhibitors, 10.2% received combination therapy, and 26.8% received neither therapy. Readmission rates were high in all groups at 1 year (warfarin, 47.5%; P2Y12 inhibitors, 46.6%; combination therapy, 38.0%; and neither therapy, 39.3%), and the overall 1-year mortality rate was 12.5%. CONCLUSIONS:Among Medicare beneficiaries with AF and ACS, combination therapy with warfarin and P2Y12 inhibitor was uncommon during the 90-day ascertainment period, and more than one-quarter of patients had no claims for warfarin or P2Y12 inhibitors. Rates of all-cause readmission and mortality within 1 year of hospitalization for ACS were high.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Jones WS,Mi X,Patel MR,Mills R,Hernandez AF,Curtis LHdoi
10.1002/clc.22231subject
Has Abstractpub_date
2014-03-01 00:00:00pages
152-9issue
3eissn
0160-9289issn
1932-8737journal_volume
37pub_type
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