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1. Use of oral anticoagulants in patients with valvular atrial fibrillation: findings from the NCDR PINNACLE Registry.

Author

Hess PL, Gosch KL, Jani SM, Varosy PD, Bradley SM, Maddox TM, Michael Ho P, and Virani SS

Subjects
Administration, Oral, Aged, Dabigatran therapeutic use, Female, Humans, Male, Practice Patterns, Physicians', Pyrazoles therapeutic use, Pyridines therapeutic use, Pyridones therapeutic use, Registries, Risk Factors, Rivaroxaban therapeutic use, Thiazoles therapeutic use, Warfarin therapeutic use, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Stroke prevention & control
Abstract

Recent data suggest direct oral anticoagulants are as safe and efficacious as warfarin among select patients with valvular heart disease and atrial fibrillation (AF). However, real-world treatment patterns of AF stroke prophylaxis in the setting of valvular AF are currently unknown. Accordingly, using the prospective, ambulatory National Cardiovascular Data Registry Practice Innovation and Clinical Excellence (PINNACLE) Registry, we sought to characterize overall use, temporal trends in use, and the extent of practice-level variation in the use of any direct oral anticoagulant and warfarin among patients with valvular AF from January 1, 2013, to March 31, 2019., (Copyright © 2021. Published by Elsevier Inc.)

Published
2021
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2. Same-day discharge among patients undergoing elective PCI: Insights from the VA CART Program.

Author

Rymer JA, O'Donnell CI, Plomondon ME, Hess PL, Donahue M, Hebert PL, Shroff A, Swaminathan RV, Waldo SW, Seto AH, Helfrich CD, and Rao SV

Subjects
Aged, Ambulatory Surgical Procedures economics, Ambulatory Surgical Procedures mortality, Cost Savings, Elective Surgical Procedures economics, Elective Surgical Procedures mortality, Female, Hospitals, High-Volume statistics & numerical data, Humans, Length of Stay economics, Length of Stay statistics & numerical data, Male, Middle Aged, Patient Discharge economics, Patient Discharge trends, Patient Readmission economics, Patient Readmission statistics & numerical data, Patient Readmission trends, Percutaneous Coronary Intervention economics, Percutaneous Coronary Intervention methods, Percutaneous Coronary Intervention mortality, Propensity Score, Time Factors, United States, United States Department of Veterans Affairs, Ambulatory Surgical Procedures statistics & numerical data, Angina, Stable surgery, Elective Surgical Procedures statistics & numerical data, Patient Discharge statistics & numerical data, Percutaneous Coronary Intervention statistics & numerical data
Abstract

Background: Available data suggest that same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is safe in select patients. Yet, little is known about contemporary adoption rates, safety, and costs in a universal health care system like the Veterans Affairs Health System., Methods: Using data from the Veterans Affairs Clinical Assessment Reporting and Tracking Program linked with Health Economics Resource Center data, patients undergoing elective PCI for stable angina between October 1, 2007 and Sepetember 30, 2016, were stratified by SDD versus overnight stay. We examined trends of SDD, and using 2:1 propensity matching, we assessed 30-day rates of readmission, mortality, and total costs at 30 days., Results: Of 21,261 PCIs from 67 sites, 728 were SDDs (3.9% of overall cohort). The rate of SDD increased from 1.6% in 2008 to 9.7% in 2016 (P < .001). SDD patients had lower rates of atrial fibrillation, peripheral arterial disease, and prior coronary artery bypass grafting and were treated at higher-volume centers. Thirty-day readmission and mortality did not differ significantly between the groups (readmission: 6.7% SDD vs 5.6% for overnight stay, P = .24; mortality: 0% vs. 0.07%, P = .99). The mean (SD) 30-day cost accrued by patients undergoing SDD was $23,656 ($15,480) versus $25,878 ($17,480) for an overnight stay. The accumulated median cost savings for SDD was $1503 (95% CI $738-$2,250)., Conclusions: Veterans Affairs Health System has increasingly adopted SDD for elective PCI procedures, and this is associated with cost savings without an increase in readmission or mortality. Greater adoption has the potential to reduce costs without increasing adverse outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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3. Implications of the FDA approval of PCSK9 inhibitors and FOURIER results for contemporary cardiovascular practice: An NCDR Research to Practice (R2P) project.

Author

Hess PL, Kennedy K, Cowherd M, Virani SS, Masoudi FA, Navar AM, Yeh RW, Ho PM, and Maddox TM

Subjects
Antibodies, Monoclonal, Humanized, Anticholesteremic Agents economics, Anticholesteremic Agents pharmacology, Cholesterol, LDL blood, Cost-Benefit Analysis, Drug Approval, Eligibility Determination methods, Female, Humans, Male, Medication Therapy Management, Middle Aged, Registries statistics & numerical data, Treatment Outcome, United States, Antibodies, Monoclonal economics, Antibodies, Monoclonal pharmacology, Arteriosclerosis blood, Arteriosclerosis drug therapy, PCSK9 Inhibitors
Published
2018
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4. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

Author

Hess PL, Mirro MJ, Diener HC, Eikelboom JW, Al-Khatib SM, Hylek EM, Bosworth HB, Gersh BJ, Singer DE, Flaker G, Mega JL, Peterson ED, Rumsfeld JS, Steinberg BA, Kakkar AK, Califf RM, and Granger CB

Subjects
Administration, Oral, Atrial Fibrillation complications, District of Columbia, Drug Therapy, Combination, Humans, Insurance Coverage, Patient Compliance, Risk Assessment, Stroke etiology, Stroke prevention & control, Anticoagulants therapeutic use, Atrial Fibrillation prevention & control, Vitamin K antagonists & inhibitors
Abstract

Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Published
2014
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