Abstract:
BACKGROUND:In patients with atrial fibrillation, incomplete adherence to anticoagulants increases risk of stroke. Non-warfarin oral anticoagulants (NOACs) are expensive; we evaluated whether higher copayments are associated with lower NOAC adherence. METHODS:Using a national claims database of commercially-insured patients, we performed a cohort study of patients with atrial fibrillation who newly initiated a NOAC from 2012 to 2018. Patients were stratified into low (<$35), medium ($35-$59), or high (≥$60) copayments and propensity-score weighted based on demographics, insurance characteristics, comorbidities, prior health care utilization, calendar year, and the NOAC received. Follow-up was 1 year, with censoring for switching to a different anticoagulant, undergoing an ablation procedure, disenrolling from the insurance plan, or death. The primary outcome was adherence, measured by proportion of days covered (PDC). Secondary outcomes included NOAC discontinuation (no refill for 30 days after the end of NOAC supply) and switching anticoagulants. We compared PDC using a Kruskal-Wallis test and rates of discontinuation and switching using Cox proportional hazards models. RESULTS:After weighting patients across the 3 copayment groups, the effective sample size was 17,558 patients, with balance across 50 clinical and demographic covariates (standardized differences <0.1). Mean age was 62 years, 29% of patients were female, and apixaban (43%), and rivaroxaban (38%) were the most common NOACs. Higher copayments were associated with lower adherence (P < .001), with a PDC of 0.82 (Interquartile range [IQR] 0.36-0.98) among those with high copayments, 0.85 (IQR 0.41-0.98) among those with medium copayments, and 0.88 (IQR 0.41-0.99) among those with low copayments. Compared to patients with low copayments, patients with high copayments had higher rates of discontinuation (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.08-1.19; P < .001). CONCLUSIONS:Among atrial fibrillation patients newly initiating NOACs, higher copayments in commercial insurance were associated with lower adherence and higher rates of discontinuation in the first year. Policies to lower or limit cost-sharing of important medications may lead to improved adherence and better outcomes among patients receiving NOACs.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Rome BN,Gagne JJ,Avorn J,Kesselheim ASdoi
10.1016/j.ahj.2020.12.010subject
Has Abstractpub_date
2021-01-14 00:00:00pages
109-121eissn
0002-8703issn
1097-6744pii
S0002-8703(20)30412-9journal_volume
233pub_type
杂志文章abstract::Asymptomatic atrial fibrillation (AF) is common and may have the same prognostic implications as symptomatic AF. Among patients receiving dual-chamber pacemakers, it is now possible to quantify asymptomatic AF accurately. Most of these episodes are of short duration, often lasting only seconds to minutes and are calle...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.02.016
更新日期:2006-09-01 00:00:00
abstract::Antiarrhythmic therapy for prevention of sustained ventricular tachycardia is commonly guided by programmed electrical stimulation, and the persistent ability to initiate ventricular tachycardia during drug therapy often leads to the use of nonpharmacologic therapies such as surgery. Prior studies suggest that program...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80325-4
更新日期:1990-04-01 00:00:00
abstract::To identify a method for characterizing the dynamic behavior of ventricular arrhythmias at different heart rates, 201 consecutive patients with frequent premature ventricular contractions (PVCs) underwent two 24-hour electrocardiographic monitoring periods. The percentage of PVCs for each cycle length was calculated a...
journal_title:American heart journal
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doi:10.1016/s0002-8703(97)70203-5
更新日期:1997-02-01 00:00:00
abstract::Myocardial reperfusion is associated with increased influx of activated neutrophils and intracellular accumulation of sodium in the ischemic zone. Lidocaine is a sodium channel blocker that also inhibits several neutrophil functions. We investigated the effect of lidocaine on infarct size in rabbits undergoing 30 minu...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70226-6
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:The randomized BASKET-PROVE study showed no significant differences between sirolimus-eluting stents (SES), everolimus-eluting stents (EES), and bare-metal stents (BMS) with respect to the primary end point, rates of death from cardiac causes, or myocardial infarction (MI) at 2 years of follow-up, in patient...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Systolic wall motion abnormality (WMA) after acute myocardial infarction (AMI) is a major determinant of outcome; the presence and importance of diastolic WMA after AMI are unknown. We therefore sought to detect diastolic WMA using color kinesis and to assess its relation to neurohormonal activation and its ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.11.024
更新日期:2005-10-01 00:00:00
abstract::The conducting tissue of the heart was studied in 25 human cases of Chagas' myocarditis with a method which employs complete serial sections mounted on continuous transparent plastic tape. The pathological changes were correlated with electrocardiographic findings. The inflammation of the acute phase of Chagas' myocar...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90362-9
更新日期:1978-03-01 00:00:00
abstract::Limited data are available on mitral valve replacement in the elderly patient. Therefore we report our 10-year experience including predictors of perioperative mortality and subsequent long-term cardiac mortality in elderly patients with mitral valve replacement compared to younger patients. Of the 126 consecutive pat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90934-n
更新日期:1992-07-01 00:00:00
abstract::Left ventricular (LV) adaptation to the hemodynamic load of pregnancy has been studied with load-sensitive ejection-phase indexes, but the results of these studies are conflicting. The aim of this study was to examine the effects of the hemodynamic load of pregnancy on the contractile state of the left ventricle by us...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70247-3
更新日期:1997-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90711-3
更新日期:1987-03-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. METHODS:Fifty patients ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2000.111104
更新日期:2000-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.02.019
更新日期:2010-05-01 00:00:00
abstract::The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90476-6
更新日期:1994-08-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70130-9
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Experimental evidence shows that activation of the autonomic nervous system influences ventricular repolarization and, therefore, the QT interval on the ECG. To test the hypothesis that the QT interval is abnormal in autonomic dysfunction, we examined ECGs in patients with severe primary autonomic failure an...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70014-6
更新日期:1998-10-01 00:00:00
abstract::Minnesota codes (MC), expressing Q-QS, ST segment, and T wave abnormalities in ECGs taken during the acute event and at a 1-year follow-up were studied in 256 survivors of myocardial infarction (MI). On the 1-year ECGs large Q waves (MC 1.1) were more common in patients with a history of previous MI than in those with...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90141-9
更新日期:1986-02-01 00:00:00
abstract::Given the preventable morbidity and mortality associated with atrial fibrillation (AF), increased awareness of undiagnosed AF, and advances in mobile electrocardiogram (ECG) technology, there is a critical need to assess the effectiveness of using such technology to routinely screen for AF in clinical practice. VITAL-...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2019.06.011
更新日期:2019-09-01 00:00:00
abstract::The single-dose pharmacokinetics of amiodarone have been studied in volunteer subjects given 400 mg doses by the intravenous and oral routes. The data show the compound to have a very large volume of distribution, a low total clearance, and a long and variable terminal elimination half-life. In patients the terminal e...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90006-6
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abstract::The aim of this study was to assess the relative value of exercise echocardiography and perfusion single-photon emission computed tomography (SPECT) in identifying the presence and severity of coronary artery stenosis. Accordingly, 44 consecutive patients with stenosis in one vessel performed simultaneous postexercise...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90922-i
更新日期:1992-07-01 00:00:00
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pub_type: 杂志文章
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.ahj.2003.08.005
更新日期:2004-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1992-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-08-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1994-06-01 00:00:00
abstract::This study investigated the correlation between cardiac abnormalities and cytosine-thymine-guanine (CTG) trinucleotide repeat expansion in patients with myotonic dystrophy (MD). We studied 18 patients with the adult form of classical MD and 18 age-matched control subjects. In patients with MD, left ventricular systoli...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70137-6
更新日期:1997-08-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(87)90754-x
更新日期:1987-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2004.03.037
更新日期:2004-08-01 00:00:00
abstract::We evaluated electrocardiographically the acute effect of captopril in the initial treatment of malignant or severe hypertension and the findings were compared with the data obtained with diazoxide. The captopril group included seven patients treated with captopril or with a combination of diuretics. The diazoxide gro...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90702-0
更新日期:1983-09-01 00:00:00
abstract::To evaluate the therapeutic efficacy of oral angiotensin-converting inhibition (ACE) with captopril in chronic normotensive congestive heart failure (CHF), acute and cardiocirculatory actions were determined by cardiac catheterization and forearm plethysmography, and ambulatory effects were assessed by echocardiograph...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90379-3
更新日期:1981-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90012-7
更新日期:1979-06-01 00:00:00