1b) This is a #journalclub review of an excellent article published in late 2022 in J Manag Care Spec Pharm 🔓 https://t.co/nKfAvbrmNB.
— cardio-met (@cardiomet_CE) January 26, 2023
👏to @ihdezdelso et al for an insightful study on a topic only gaining in importance as the population ages. pic.twitter.com/4LYW6GZohs
2b) This #tweetorial is supported by an unrestricted educational grant from Anthos Therapeutics.#Physicians #PhysicianAssociates #Nurses #NursePractitioners #Pharmacists all earn credit! FOLLOW US more weekly expert-authored education and 🆓credit in the #cardiometabolic space!
— cardio-met (@cardiomet_CE) January 26, 2023
3b) Fascinating words: "#Underprescribing" and "#Underfilling"–the first isn't even in my SpellCheck dictionary, but we #clinicians all know it when we see it. And in the #SPAF world, it stems from fear 😱of bleeding 🩸on the part of the #HCP. pic.twitter.com/NjBWMrVXKy
— cardio-met (@cardiomet_CE) January 26, 2023
3d) Then again, pt concern about 🩸can interfere with adherence to #OAC for #SPOAF: That's the #underfilling. @ihdezdelso et al again: per 🔓 https://t.co/kqYtRnElmy, only 50% of #AF pts Rx'd #OAC for #SPAF use their 💊, and <50% adhere to OAC.
— cardio-met (@cardiomet_CE) January 26, 2023
3f) Trajectories were associated not only with demographic and clinical characteristics but also with regional factors. pic.twitter.com/vD5G774RZk
— cardio-met (@cardiomet_CE) January 26, 2023
5) This is SUCH an important issue because we KNOW pts with #AFib benefit from #OAC to ⬇️#stroke risk, & #AF is a strong risk factor for ischemic stroke; it is implicated in 15%-20% of stroke cases and is the main cause of ischemic stroke in older adult individuals. pic.twitter.com/ttv3G8H9KX
— cardio-met (@cardiomet_CE) January 26, 2023
7a) In this analysis they identified pts who were newly diagnosed with #AF between 1/1/2013 & 6/30/2017 (n = 89,460). They excluded pts with #valvular disease, as current @US_FDA labeling for #DOACs for #SPAF specifically targets #nonvalvular #AFib.
— cardio-met (@cardiomet_CE) January 26, 2023
8a) Vs pts who were Rx'd an #OAC, pts who were not Rx'd were younger, less likely to be enrolled in Medicare Advantage plans, & more likely to have a lower CHA2DS2-VASc score. pic.twitter.com/nQSSguh0yW
— cardio-met (@cardiomet_CE) January 26, 2023
9) What about FILLING those Rxs?
— cardio-met (@cardiomet_CE) January 26, 2023
🔑 Of the pts Rx'd #OAC within 150d of #AF dx, 81% had their Rx filled w/i 6mos ➡️underfilling was estimated at 19%.
🔑 Vs pts who filled Rx, those who did not fill were more likely to be aged 75+yrs, enrolled in Medicare, & live in the Midwest pic.twitter.com/4EWvhGX2r9
10b)
— cardio-met (@cardiomet_CE) January 26, 2023
👉Non-#HMO health plans were assoc'd w/ higher likelihood of being Rx'd #OAC
👉Pts who were younger, had a lower #CHA2DS2_VASc score, or had a higher #HAS_BLED score were less likely to be Rx'd OACs. pic.twitter.com/vPboqFXKK4
11b)
— cardio-met (@cardiomet_CE) January 26, 2023
👉Further, pts who were younger and enrolled in an #HMO health plan were less likely to fill an #OAC prescription. pic.twitter.com/Sc9Nw73sGu
12b) Further, despite all the literature of the past decade highlighting the ease, #cost_effectiveness, and safety of #DOACs vs #warfarin for #PSAF, pts Rx'd DOACs were 1 to 1.5 x LESS likely to fill the Rx than those prescribed warfarin.
— cardio-met (@cardiomet_CE) January 26, 2023
14a) It seems that the biggest issue underpinning this alarming deficit is concern for bleeding, which can lead to withholding #OAC altogether or Rx'ing subtherapeutic "safer" doses (⤴️tweet 3c).
— cardio-met (@cardiomet_CE) January 26, 2023
14c) Perhaps the final frontier for anticoagulation is inhibition at the #FXI/XIa step (see, for example, https://t.co/w396TRgnC4) pic.twitter.com/BFaEAI7BAf
— cardio-met (@cardiomet_CE) January 26, 2023
15b) In the case of #OACs, add the negative impact of nuisance bleeding, and we have a continuing problem with successful #SPAF even when we prescribe the right regimen every time!
— cardio-met (@cardiomet_CE) January 26, 2023
16b) We've tried this in the past; remember #idraparinux? The safety wasn't there (🔓 https://t.co/hvFQ2eoPzi). Again, perhaps inhibition of #FXI may be an emerging effective AND safe solution. Time will tell.
— cardio-met (@cardiomet_CE) January 26, 2023
18a) So based on the article, which is FALSE?
— cardio-met (@cardiomet_CE) January 26, 2023
a. underprescribing is more common than underfilling
b. DOAC Rx are underfilled > than warfarin Rx
c. majority of pts dx’d w/ AF are started on #OAC in 6 mos
d. Medicare pts are less likely to fill OAC than pts w/commercial insurance.
19a) Based on #CHADS2_Vasc score, pts at higher risk of stroke in this study were more likely to receive an #OAC Rx after diagnosis of #Afib than were patients at lower risk. True or False?
— cardio-met (@cardiomet_CE) January 26, 2023
20) Follow us here on @cardiomet_ce for more education and 🆓CE/#CME on this and other topics related to #thrombosis and #antithrombotic therapy!
— cardio-met (@cardiomet_CE) January 26, 2023
For now, grab your certificate for credit from today's program at https://t.co/mHOQVw4Uba. I am @md_pollack. Thanks for joining us!