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Multicenter Study
. 2018 Sep;41(9):1136-1143.
doi: 10.1002/clc.23042. Epub 2018 Sep 22.

Association of Healthcare Plan with atrial fibrillation prescription patterns

Andrew Young Chang  1 , Mariam Askari  2 , Jun Fan  2 , Paul A Heidenreich  1   2 , P Michael Ho  3   4 , Kenneth W Mahaffey  1 , Aditya Jathin Ullal  1 , Alexander Carroll Perino  1 , Mintu P Turakhia  1   2
Affiliations
Multicenter Study

Association of Healthcare Plan with atrial fibrillation prescription patterns

Andrew Young Chang et al. Clin Cardiol. 2018 Sep.

Abstract

Background: Atrial fibrillation (AF) is treated by many types of physician specialists, including primary care physicians (PCPs). Health plans have different policies for how patients encounter these providers, and these may affect selection of AF treatment strategy.

Hypothesis: We hypothesized that healthcare plans with PCP-gatekeeping to specialist access may be associated with different pharmacologic treatments for AF.

Methods: We performed a retrospective cohort study using a commercial pharmaceutical claims database. We utilized logistic regression models to compare odds of prescription of oral anticoagulant (OAC), non-vitamin K-dependent oral anticoagulant (NOAC), rate control, and rhythm control medications used to treat AF between patients with PCP-gated healthcare plans (eg, HMO, EPO, POS) and patients with non-PCP-gated healthcare plans (eg, PPO, CHDP, HDHP, comprehensive) between 2007 and 2012. We also calculated median time to receipt of therapy within 90 days of index AF diagnosis.

Results: We found similar odds of OAC prescription at 90 days following new AF diagnosis in patients with PCP-gated plans compared to those with non-PCP-gated plans (OR: OAC 1.01, P = 0.84; warfarin 1.05, P = 0.08). Relative odds were similar for rate control (1.17, P < 0.01) and rhythm control agents (0.93, P = 0.03). However, PCP-gated plan patients had slightly lower likelihood of being prescribed NOACs (0.82, P = 0.001) than non-gated plan patients. Elapsed time until receipt of medication was similar between PCP-gated and non-gated groups across drug classes.

Conclusions: Pharmaceutical claims data do not suggest that PCP-gatekeeping by healthcare plans is a structural barrier to AF therapy, although it was associated with lower use of NOACs.

Keywords: arrhythmia/all; atrial fibrillation; socio-economic aspects; thrombosis/hypercoagulable states.

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Conflict of interest statement

Andrew Young Chang: None; Mariam Askari: None; Jun Fan: None; Paul A. Heidenreich: None; P. Michael Ho: Janssen Pharmaceuticals, American Heart Association; Kenneth W. Mahaffey: Ablynx, Afferent, Amgen, AstraZeneca, BAROnova, Bio2 Medical, BioPrint Fitness, Boehringer Ingelheim, Bristol Myers Squibb, Cardiometabolic Health Congress, Cubist, Daiichi, Eli Lilly, Elsevier, Epson, Ferring, Glaxo Smith Kline, Google (Verily), Johnson & Johnson, Medtronic Inc., Merck, Mt. Sinai, Myokardia, Novartis, Oculeve, Portola, Radiomeer, Sanofi, Springer Publishing, St Jude Medical, The Medicine Company, Theravance, UCSF, Vindico, WebMD; Aditya Jathin Ullal: None; Alexander Carroll Perino: None; Mintu P. Turakhia: Janssen Pharmaceuticals, Medtronic Inc., AztraZeneca, Veterans Health Administration, AliveCor, St. Jude Medical, Boehringer Ingelheim, Precision Health Economics, Zipline Medical, iBeat Inc., Akebia, Cardiva Medical, Medscape/theheart.org, Amazon, iRhythm, JAMA Cardiology.

Figures

Figure 1
Figure 1
Flow diagram: Summary of the inclusion/exclusion criteria for developing the study cohort
See this image and copyright information in PMC

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