1b) #CKD is an independent risk factor for subsequent #AFib. Management of #AF can be quite challenging in pts with CKD, and medical therapy for #SPAF should take into account the complications of thromboembolic events and bleeding when clearance of #anticoagulants is limited.
— @CKD_ce (@ckd_ce) April 5, 2023
2a) Your host is 🩸clot, #antithrombotictherapy, and #atrialfib aficionado Charles Pollack MD @md_pollack from @UMMCnews, working to create #AHealthierMS. Earn 0.5hr 🆓CE/#CME by following this 🧵.
— @CKD_ce (@ckd_ce) April 5, 2023
Statement of accreditation and faculty disclosures at https://t.co/PHlIppl6Yw. pic.twitter.com/uv3D7YF1l3
3a) Our discussion article for this #JournalClub is entitled "Underprescribing vs underfilling to oral anticoagulation: An analysis of linked medical record and claims data for a nationwide sample of patients with atrial fibrillation."
— @CKD_ce (@ckd_ce) April 5, 2023
That ref again: 🔓 https://t.co/JEONkRAjhh
3c) We've seen this before with #DOACs
— @CKD_ce (@ckd_ce) April 5, 2023
👉#apixaban: 🔓 https://t.co/trbebh5Nje
👉#rivaroxaban: 🔓 https://t.co/VHbWnGlaTR
😱The real problem with #underdosing #DOAC: the pt absorbs the ⬆️🩸risk of #anticoagulation, even if subtherapeutic, but without intended #SPAF benefit! pic.twitter.com/RNb4F7FHnp
3e) And in that study of data from 2014-15, they identified 4 distinct trajectories of OAC adherence after first #AF diagnosis, with <45% of newly diagnosed AF patients belonging to the trajectory group characterized by continuous #OAC adherence.
— @CKD_ce (@ckd_ce) April 5, 2023
4) And so to characterize this issue in contemporary practice, these authors utilized leveraged Optum Integrated Claims #EHR data to quantify the extent to which #OAC underuse is due to #underprescribing vs #underfilling after the 💊 is prescribed. pic.twitter.com/QRwJuZqTty
— @CKD_ce (@ckd_ce) April 5, 2023
6) The #EHR data ➡️prescriptions ordered by providers, and claims data ➡️ prescription fill records by patients. The authors also evaluated patient-, provider-, & health plan–related factors associated with #underprescribing #OACs and #underfilling after OACs were prescribed. pic.twitter.com/LF5ab7xZe7
— @CKD_ce (@ckd_ce) April 5, 2023
7b) They also excluded pts with incomplete data sets (for various reasons) to yield a final study cohort of n = 6,141). Mean age was 72y; 47% were ♀️ and 82% were White.
— @CKD_ce (@ckd_ce) April 5, 2023
🔑 51% of that cohort were NOT prescribed an #OAC within 6 months of their AF diagnosis pic.twitter.com/UrDmrwaE3t
8b) Among those at high stroke risk (#CHA2DS2_VASc score of ≥ 1 in ♂️ and ≥ 2 in ♀️ ), 49% were not prescribed an #OAC within 6 months of their AF diagnosis, which was comparable with the overall cohort. pic.twitter.com/9BuWFIZcrN
— @CKD_ce (@ckd_ce) April 5, 2023
10a) So let's look at clinical & sociodemographic factors for #underPRESCRIBING:
— @CKD_ce (@ckd_ce) April 5, 2023
👉Vs pts in the Midwest, living in the Northeast or
the South was associated with a higher likelihood of not being Rx'd. pic.twitter.com/9oLWpVRkGW
11a) What about #underFILLING? Underfilling after the 💊 was Rx'd (what these authors call "primary #nonadherence by pts”). Pts were less likely to fill
— @CKD_ce (@ckd_ce) April 5, 2023
👉 #DOAC Rxs than #warfarin Rxs
👉if enrolled in #Medicare_Advantage plans vs commercial insurance
12a) So what does this all mean? The authors pointed to their findings that #underuse of #OACs is mostly driven by #underprescribing. Still, ~20% of patients with #AF who were Rx'd OAC did not fill it.
— @CKD_ce (@ckd_ce) April 5, 2023
13) So, fellow clinicians, we have two problems here. First, solutions start with US. Despite longstanding data that early initiation of #SPAF ➡️ significant ⬇️in #AF-related ischemic strokes, > half of pts newly diagnosed with AF are not prescribed OACs within 6 months of dx!
— @CKD_ce (@ckd_ce) April 5, 2023
14b) An anticoagulation strategy safer even than #DOACs could impact this, but for now we are dependent on #HCP education pic.twitter.com/saLZahvgXx
— @CKD_ce (@ckd_ce) April 5, 2023
15a) But we also have to do a much better job of educating, encouraging, cajoling, etc etc our patients with #AF of the importance of adherence to therapy once properly Rx'd!
— @CKD_ce (@ckd_ce) April 5, 2023
🔑 We know that 💊that don't treat symptoms are less likely to be taken regularly.
16a) To address this "primary nonadherence" we need safer (still) #anticoagulation therapies (so ⬇️nuisance bleeding as well as major 🩸), and meds that perhaps don't require remembering to take them every day.
— @CKD_ce (@ckd_ce) April 5, 2023
17) But while we are waiting for ⌛️to pass, our index article for this tweetorial sheds important light on today's #SPAF reality: pic.twitter.com/AwV8X0YE1s
— @CKD_ce (@ckd_ce) April 5, 2023
18b) It’s c. Sad to say that even 6 mos after new AFib dx, > half of pts newly diagnosed with AF are not prescribed OACs within 6 months of dx!
— @CKD_ce (@ckd_ce) April 5, 2023
19b) Alas, it is FALSE. As per tweet 8b, among those at high stroke risk (#CHA2DS2_VASc score ≥ 1 in ♂️ & ≥ 2 in ♀️ ), 49% of pts were NOT prescribed an #OAC within 6 months of their AF dx, which was in fact comparable with the overall cohort.
— @CKD_ce (@ckd_ce) April 5, 2023
Holy 🐄, so much room to improve!
20) So you just earned 0.5hr 🆓CE/#CME! Easy, huh? FOLLOW US and let’s do it again!
— @CKD_ce (@ckd_ce) April 5, 2023
For now, grab your certificate for credit from today's program at https://t.co/4WsifDri5w. I am @md_pollack. Thanks for joining us!