Abstract 15978: Combined Use of Warfarin and Oral P2Y12 Inhibitors in Patients With Atrial Fibrillation and Acute Coronary Syndrome
Background: Although atrial fibrillation (AF) occurs frequently in patients hospitalized with acute coronary syndrome (ACS), strategies for prevention of thromboembolic complications are poorly characterized. We sought to describe patients with AF and ACS who were treated with warfarin, P2Y12 inhibitors, combination (warfarin + P2Y12 inhibitors) therapy, or neither therapy, and examine clinical outcomes.
Methods and Results: Hospitalized patients greater than 65 years of age with a primary diagnosis of ACS and a secondary diagnosis of AF were identified in the 5% Medicare inpatient claims from 2007 to 2010. Medication exposure was ascertained within 90 days following the index discharge using the Medicare Part D claims. Among patients who were event-free within 90 days of index discharge, we examined baseline characteristics and cumulative incidence of all-cause mortality and all-cause readmission by treatment groups. A total of 2,509 Medicare beneficiaries fulfilled the inclusion criteria. Within 90 days of index discharge, 35% of patients were readmitted. Of those patients who were not readmitted, 24.0% received warfarin, 38.9% received P2Y12 inhibitors, 10.2% received combination therapy, and 26.8% had 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%)]. Overall, there was a high 1-year mortality rate in all groups [warfarin (11.7%), P2Y12 inhibitors (12.5%), neither therapy (15.8%)] following ACS and AF admission [Table]. There were too few deaths in the group treated with combination therapy to report.
Conclusions: Combination therapy with warfarin and P2Y12 inhibitor is uncommon among Medicare beneficiaries. Over one-quarter of patients with both AF and ACS did not fill a prescription for warfarin or P2Y12 inhibitor. The readmission rates and overall mortality of Medicare beneficiaries with concomitant AF and ACS are high.
- © 2013 by American Heart Association, Inc.