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Portas L, Bauersachs R, Bowrin K, Briere JB, Cohen A, Huelsebeck M, Jones S, Quint JK. Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England. Vasc Med 2022; 27:440-449. [PMID: 35670290 PMCID: PMC9551319 DOI: 10.1177/1358863x221096704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Symptoms, severity, and acuteness of peripheral artery
disease (PAD) are major determinants of severe limb symptoms, subsequent risk of
cardiovascular events, and mortality. Lower-extremity revascularization (LER) is
a key option to relieve symptoms and to prevent limb loss in symptomatic
patients with PAD. This study aimed to quantify the burden of disease among
patients with PAD-LER in England. Methods: A retrospective
population-based study of linked primary and secondary care electronic health
records, included 13,869 adult patients (aged ⩾ 18 years) with PAD-LER from 2003
to 2018. The incidence of first ever PAD-LER was estimated both overall and by
type of procedure (endovascular/surgical). Health resource utilization
associated with PAD-related complications and treatment patterns were assessed.
Results: A high annual incidence of lower-limb
revascularization (41.2 per 1000 person years) and a nearly double incidence of
endovascular first revascularization compared with open surgery were observed.
More than 70% of patients with PAD-LER had a history of hyperlipidemia and
hypertension and roughly one-third were diabetic and had a history of coronary
artery disease. Cardiovascular mortality accounted for one-third (34.1 per 1000
person years) of all-cause mortality. Over 93% of patients were hospitalized for
any reason and the commonest reasons for hospitalization were cardiovascular
diseases and PAD with about one-third hospitalized for revascularization
reoccurrence. Conclusion: There is a significant burden of PAD-LER
to the individual and society with ongoing healthcare resource utilization,
treatment, and increasing mortality.
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Affiliation(s)
- Laura Portas
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rupert Bauersachs
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Darmstadt, Germany
| | | | | | - Alexander Cohen
- Department of Hematological Medicine, Guy's & St Thomas' NHS Foundation Trust, King's College London, London, UK
| | | | - Schuyler Jones
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Blomström Lundqvist C, Själander S, Garcia Rodriguez LA, Åkerborg Ö, Jin G, Caleyachetty A, Huelsebeck M, Bowrin K, Schaefer B, Mahdessian H, Hofmeister L, Levin LÅ. Impact of non-adherence to direct oral anticoagulants amongst Swedish patients with non-valvular atrial fibrillation: results from a real-world cost-utility analysis. J Med Econ 2022; 25:1085-1091. [PMID: 35997241 DOI: 10.1080/13696998.2022.2116848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIMS A third of non-valvular atrial fibrillation (NVAF) patients are non-adherent to direct oral anticoagulants (DOACs). Estimates of the economic value of full adherence and the cost of two types of adherence improving interventions are important to healthcare planners and decision-makers. METHODS A cost-utility analysis estimated the impact of non-adherence over a 20-year horizon, for a patient cohort with a mean age of 77 years, based on data from the Stockholm Healthcare database of NVAF patients with incident stroke between 2011 and 2018. Adherence was defined using a medication possession ratio (MPR) cut-off of 90%; primary outcomes were the number of ischemic strokes and associated incremental cost-utility ratio. RESULTS Hypothetical comparisons between cohorts of 1,000 patients with varying non-adherence levels and full adherence (MPR >90%) predicted an additional number of strokes ranging from 117 (MPR = 81-90%) to 866 (MPR <60%), and years of life lost ranging from 177 (MPR = 81- 90%) to 1,318 (MPR < 60%; discounted at 3%). Chronic disease co-management intervention occurring during each DOAC prescription renewal and patient education intervention at DOAC initiation will be cost-saving to the health system if its cost is below SEK 143 and SEK 4,655, and cost-effective if below SEK 858 and SEK 28,665, respectively. CONCLUSION Adherence improving interventions for NVAF patients on DOACs such as chronic disease co-management and patient education can be cost-saving and cost-effective, within a range of costs that appear reasonable to the Swedish healthcare system.
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Affiliation(s)
- Carina Blomström Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sara Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Schindewolf M, Beyer-Westendorf J, Balradj J, Bowrin K, Huelsebeck M, Briere JB. Systematic Literature Review of Randomized Trials Comparing Antithrombotic Therapy Following Revascularization Procedures in Patients With Peripheral Artery Disease. Angiology 2020; 71:773-790. [PMID: 32638610 DOI: 10.1177/0003319720936505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A systematic literature review was conducted to identify and summarize the clinical efficacy and safety of available antithrombotic therapies after peripheral endovascular or surgical revascularization in patients with peripheral artery disease (PAD). Five databases were searched using free-text and Emtree/Mesh terms for PAD, randomized controlled trials (RCTs), and antithrombotic therapies of interest (ie, single antiplatelet therapy, dual antiplatelet therapy, and vitamin K antagonists). Randomized controlled trials were eligible for inclusion if they assessed the risk of thrombotic events (ie, myocardial infarction, ischemic stroke, cardiovascular death, limb ischemia, or limb amputation) or safety profile (ie, minor, moderate, major, or fatal bleeding events) after revascularization. In total, 16 RCTs were identified. Only a few studies reported on treatment effects of the investigated therapies. Myocardial infarction, ischemic stroke, cardiovascular death, and amputation were reported in up to 2.3%, 2.3%, 5.6%, and 7.3% of patients, respectively. Bleeding events were observed in up to 8.4% (major) and 1.5% (fatal) of patients. Despite available treatments, patients with PAD undergoing revascularization remain at risk of thrombotic events. There is a need for new treatments that will help to optimize care for patients with symptomatic PAD undergoing revascularization.
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Affiliation(s)
- Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, 27252Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Division Hematology, Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.,King's Thrombosis Service, Department of Hematology, King's College London, London, United Kingdom
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Bauersachs R, Debus S, Nehler M, Huelsebeck M, Balradj J, Bowrin K, Briere JB. A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease. Angiology 2019; 71:303-314. [DOI: 10.1177/0003319719896477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.
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Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmBH, Darmstadt, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery, Angiology, Endovascular Interventions, University of Hamburg-Eppendorf, Hamburg Germany
| | - Mark Nehler
- Vascular Surgery and Endovascular Therapy Faculty, University of Colorado and CPC Research, Denver, CO, USA
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Bauersachs R, Zeymer U, Brière JB, Marre C, Bowrin K, Huelsebeck M. Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review. Cardiovasc Ther 2019; 2019:8295054. [PMID: 32099582 PMCID: PMC7024142 DOI: 10.1155/2019/8295054] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Atherothrombotic disease, including coronary artery disease (CAD) and peripheral artery disease (PAD), can lead to cardiovascular (CV) events, such as myocardial infarction, stroke, limb ischemia, heart failure, and CV death. AIM Evaluate the humanistic and economic burden of CAD and PAD and identify unmet needs through a comprehensive literature review. METHODS Relevant search terms were applied across online publication databases. Studies published between January 2010 and August 2017 meeting the inclusion/exclusion criteria were selected; guidelines were also included. Two rounds of screening were applied to select studies of relevance. RESULTS Worldwide data showed approximately 5-8% prevalence of CAD and 10-20% prevalence of PAD, dependent on the study design, average age, gender, and geographical location. Data from the REACH registry indicated that 18-35% of patients with CAD and 46-68% of patients with PAD had disease in one or more vascular beds. Use of medication to control modifiable CV risk factors was variable by country (lower in France than in Canada); statins and aspirin were the most widely used therapies in patients with chronic disease. Survival rates have improved with medical advancements, but there is an additional need to improve the humanistic burden of disease (i.e., associated disability and quality of life). The economic burden of atherothrombotic disease is high and expected to increase with increased survival and the aging population. CONCLUSION CAD and PAD represent a substantial humanistic and economic burden worldwide, highlighting a need for new interventions to reduce the incidence of atherothrombotic disease.
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Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
- Center of Thrombosis and Haemostasis, University of Mainz, Mainz, Germany
| | - Uwe Zeymer
- Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen am Rhein, Germany
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Bonnemeier H, Huelsebeck M, Kloss S. Comparative effectiveness of rivaroxaban versus a vitamin K antagonist in patients with renal impairment treated for non-valvular atrial fibrillation in Germany - A retrospective cohort study. Int J Cardiol Heart Vasc 2019; 23:100367. [PMID: 31111087 PMCID: PMC6510975 DOI: 10.1016/j.ijcha.2019.100367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/02/2019] [Accepted: 04/22/2019] [Indexed: 11/09/2022]
Abstract
Background The risk of thromboembolic events is increased in patients with non-valvular atrial fibrillation (NVAF) and renal impairment. The risk of bleeding events is increased if these patients are treated with anticoagulants and further increased in those with active cancer. Methods RELOAD, a retrospective database study, assessed the outcomes of patients with NVAF prescribed rivaroxaban versus phenprocoumon. Here, we present a subgroup analysis evaluating effectiveness and safety of rivaroxaban versus phenprocoumon in patients with NVAF and renal impairment. Analyses were additionally stratified by patients with and without evidence of cancer at baseline. Results When using the ‘one tablet per day’ definition of estimating drug exposure time, the incidence of the primary endpoint of ischaemic stroke was significantly lower in patients (without evidence of cancer at baseline) receiving rivaroxaban 15 mg or 20 mg once daily versus those receiving phenprocoumon (2.40 vs 3.51 events per 100 patient-years, respectively; hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.55–0.94, p = 0.015); with the incidence of the primary safety outcome of intracranial haemorrhage being numerically lower (0.57 vs 0.89 events per 100 patient-years, respectively; HR = 0.66, 95% CI 0.38–1.14, p = 0.14). Similar results were observed when using the ‘empirical defined daily dose’ definition to estimate drug exposure time and when including patients with evidence of cancer. Conclusion The prescription of rivaroxaban in patients with NVAF and renal impairment was associated with a lower incidence of ischaemic stroke and intracranial haemorrhage versus phenprocoumon in patients without evidence of cancer.
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Key Words
- AF, atrial fibrillation
- CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥ 75 years (2 points), Diabetes mellitus, Stroke or transient ischaemic attack (2 points), Vascular disease, Age 65–74, Sex category (female)
- CHADS2, Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke or transient ischaemic attack (2 points)
- CI, confidence interval
- DOAC, direct oral anticoagulant
- HAS-BLED, Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalised ratio, Elderly, Drugs/alcohol concomitantly
- HR, hazard ratio
- ICD-10, International Classification of Diseases Tenth Revision
- ICH, intracranial haemorrhage
- NVAF, non-valvular atrial fibrillation
- Non-valvular atrial fibrillation
- PY, patient-years
- Phenprocoumon
- RELOAD study
- Renal impairment
- Rivaroxaban
- TIA, transient ischaemic attack
- VKA, vitamin K antagonist
- eDDD, empirical defined daily dose
- od, once daily
- pPDD, personalised prescribed daily dose
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Affiliation(s)
- Hendrik Bonnemeier
- Department of Electrophysiology and Rhythmology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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Bonnemeier H, Mundhenke M, Von Mach T, Huelsebeck M. P3600Characteristics of 15mg od rivaroxaban patients from the RELOAD study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bonnemeier H, Mundhenke M, Von Mach T, Huelsebeck M. P3581Real-world effectiveness of stroke prevention in patients with non-valvular atrial fibrillation treated with rivaroxaban vs. phenprocoumon in Germany - insights from the reload study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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