Predictors of warfarin use among Ohio Medicaid patients with new-onset nonvalvular atrial fibrillation
Predictors of warfarin use among Ohio Medicaid patients with new-onset nonvalvular atrial fibrillation
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DOI：
10.1001/archinte.163.14.1705
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发表时间：
2003-07-28
影响因子：
--
通讯作者：
Eckman, MH
中科院分区：
文献类型：
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作者：
Johnston, JA;Cluxton, RJ;Eckman, MH
背景：尽管华法林在卒中预防方面有明显疗效，但在房颤（AF）患者中的应用不足。不使用华法林的原因尚不清楚。方法：我们使用俄亥俄州医疗补助管理账单数据进行回顾性队列分析，以确定新发非瓣膜性房颤患者使用华法林的决定因素。数据库包括来自所有为俄亥俄州医疗补助入入者提供服务的机构、提供者和药房的数据。受试者包括1998年1月1日至2000年12月31日期间所有11699名连续登记的俄亥俄州医疗补助计划的服务收费接受者，这些接受者新诊断为非瓣膜性房颤。我们通过检索相应的国际疾病分类、第九次修订、临床修改代码和国家药品代码的索赔记录来确定华法林的早期使用和卒中和出血的危险因素的存在。进行单变量和多变量分析以检查危险因素与华法林使用的关联。结果：只有9.7%的患者和11.9%的无明显禁忌症的患者在房颤发生前7天至30天内使用华法林处方。高血压和充血性心力衰竭独立预测华法林使用增加。年龄较大（大于或等于85岁），年龄较小(
Background: Despite demonstrated efficacy in stroke prevention, warfarin is underused in patients with atrial fibrillation (AF). Reasons for warfarin nonuse are unclear.Methods: We conducted a retrospective cohort analysis using Ohio Medicaid administrative billing data to ascertain determinants of warfarin use for patients with new-onset nonvalvular AF. The database included data from all institutions, providers, and pharmacies providing services to Ohio Medicaid enrollees. Subjects included all 11699 continuously enrolled fee-for-service recipients of Ohio Medicaid with a new diagnosis of nonvalvular AF between January 1, 1998, and December 31, 2000. We determined incipient warfarin use and presence of risk factors for stroke and hemorrhage by searching claims records for corresponding International Classification of Diseases, Ninth Revision, Clinical Modification codes and National Drug Codes. Univariate and multivariable analyses were performed to examine the association of risk factors with warfarin use.Results: Only 9.7% of all patients and 11.9% of those without apparent contraindications filled prescriptions for warfarin from 7 days preceding to 30 days after the development of AF. Hypertension and congestive heart failure independently predicted increased warfarin use. Older age (greater than or equal to85 years), younger age (