TY - JOUR
T1 - Us antiarrhythmic drug treatment for patients with atrial fibrillation
T2 - An insurance claims–based report
AU - Tardos, Jonathan G.
AU - Ronk, Christopher J.
AU - Patel, Miraj Y.
AU - Koren, Andrew
AU - Kim, Michael H.
N1 - Funding Information:
Medical writing assistance, under the direction of the authors, was provided by Gauri Saal, MA Economics, and Claire Fielden, PhD; editorial support was provided by Caroline Ayres, MPH, all of Prime, Knutsford, Cheshire, UK, funded by Sanofi, according to Good Publication Practice guidelines (http://annals. org/aim/fullarticle/2424869/good-publication-practice-communicating-company-sponsored-medical-research-gpp3). The sponsor was involved in the study design and collection, analysis, and interpretation of data, as well as data checking of information provided in the manuscript. The authors had unrestricted access to study data, were responsible for all content and
Publisher Copyright:
© 2021 The Authors and Sanofi. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Current American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines and European Society of Cardiology guidelines recommend antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in patients with atrial fibrillation. We assessed the concordance between healthcare provider real-world practice and current guidelines with respect to first-line AAD rhythm management. METHODS AND RESULTS: Administrative claims data from the deidentified Optum Clinformatics Data Mart database were used. Patients were included if they were initiated on an AAD in 2015 to 2016, had 1 year of continuous data availability before their first AAD pharmacy claim, and had a diagnosis for atrial fibrillation within that period. Concordance was assessed by comparing the AAD initiated by the healthcare provider against guideline recommendations for first-line treatment, given the presence of heart failure, coronary artery disease, both, or neither (as determined by International Classification of Diseases, Ninth Revision and Tenth Revision [ICD-9 and ICD-10] codes). Concordance was also assessed by provider type using Medicare taxonomy codes. For the 15 445 patients included, 51% of healthcare providers initiated AAD treatments with amiodarone, 18% flecainide, 15% sotalol, 8% dronedarone, 5% propafenone, and 2% dofetilide. The overall rate of guideline concordance was 61%, with differences by provider type: 67% for electrophysiologists, 61% for cardiologists, and 60% for others (internal medicine, etc). CONCLUSIONS: There continues to be a sizable gap in concordance between practice and guidelines in first-line rhythm management of patients with atrial fibrillation. Further research is needed to identify possible explanations for non– guideline-recommended use of AADs, in addition to enhanced AAD educational strategies for practitioners.
AB - BACKGROUND: Current American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines and European Society of Cardiology guidelines recommend antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in patients with atrial fibrillation. We assessed the concordance between healthcare provider real-world practice and current guidelines with respect to first-line AAD rhythm management. METHODS AND RESULTS: Administrative claims data from the deidentified Optum Clinformatics Data Mart database were used. Patients were included if they were initiated on an AAD in 2015 to 2016, had 1 year of continuous data availability before their first AAD pharmacy claim, and had a diagnosis for atrial fibrillation within that period. Concordance was assessed by comparing the AAD initiated by the healthcare provider against guideline recommendations for first-line treatment, given the presence of heart failure, coronary artery disease, both, or neither (as determined by International Classification of Diseases, Ninth Revision and Tenth Revision [ICD-9 and ICD-10] codes). Concordance was also assessed by provider type using Medicare taxonomy codes. For the 15 445 patients included, 51% of healthcare providers initiated AAD treatments with amiodarone, 18% flecainide, 15% sotalol, 8% dronedarone, 5% propafenone, and 2% dofetilide. The overall rate of guideline concordance was 61%, with differences by provider type: 67% for electrophysiologists, 61% for cardiologists, and 60% for others (internal medicine, etc). CONCLUSIONS: There continues to be a sizable gap in concordance between practice and guidelines in first-line rhythm management of patients with atrial fibrillation. Further research is needed to identify possible explanations for non– guideline-recommended use of AADs, in addition to enhanced AAD educational strategies for practitioners.
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U2 - 10.1161/JAHA.120.016792
DO - 10.1161/JAHA.120.016792
M3 - Article
C2 - 33686868
AN - SCOPUS:85103227341
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 6
M1 - e016792
ER -