2010 123(7):638.e4–645.e4.Ĭonnolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Ogilvie IM, Newton N, Welner SA, Cowell W, Lip GYH. Epidemiology and outcomes in patients with atrial fibrillation in the United States. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Gage BF, Boechler M, Doggette AL, Fortune G, Flaker GC, Rich MW, et al. National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, et al. Is bleeding a necessary evil? The inherent risk of antithrombotic pharmacotherapy used for stroke prevention in atrial fibrillation. Myat A, Ahmad Y, Haldar S, Tantry US, Redwood SR, Gurbel PA, et al. Does heart failure confer a hypercoagulable state? Virchow’s triad revisited. Atrial fibrillation: an epidemic in the elderly. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJV. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Factors associated with the epidemic of hospitalizations due to atrial fibrillation. Wong CX, Brooks AG, Lau DH, Leong DP, Sun MT, Sullivan T, et al. Public subsidisation and the development of antidotes (such as vitamin K for warfarin) for the new oral anticoagulants may have a positive effect on the under-treatment of AF. Conclusionsīased on the study sample and the modelled attributes, the overall profiles of the new oral anticoagulants were preferred to warfarin as their cost decreased. Predicted use of the new oral anticoagulants (and under-treatment of AF) using simulation, given moderate-to-high risk of stroke, is 25 % (52 %), 54 % (29 %) and 70 % (21 %) assuming a market price of AUD$120/month, AUD$30/month (subsidised price) and AUD$30/month with an antidote, respectively. Efficacy (stroke risk) was more important than safety (bleed risk, antidote), which were both considerably more important than convenience factors (blood tests, dose frequency, drug or food interactions). Seventy-six participants were recruited and completed the study. Relative value was explored via estimation of marginal rates of substitution with predicted probability analysis used to simulate potential uptake of oral anticoagulants. Choice data were modelled using mixed rank-ordered logit. Participants completed a computerised best–best discrete choice experiment (and follow-up interview) as if they had AF with a moderate-to-high risk of stroke. This study was conducted in Melbourne, Australia, with members of the general public with or without AF aged ≥40 years, where those without AF proxy for newly-diagnosed patients. The aim of this study is to examine: (1) patient preferences for attributes of warfarin and the new oral anticoagulants (dabigatran, rivaroxaban, apixaban) in AF (2) which attributes are most important and (3) whether current under-treatment is likely to improve with the new oral anticoagulants. Under-treatment with oral anticoagulants has been a significant challenge of treatment, historically related to patient concerns over the safety and convenience of warfarin, which until recently was the only oral anticoagulant available. Atrial fibrillation (AF) is recognised as a growing clinical and public health problem in many countries, owing to disability and death from stroke associated with the condition, high hospitalisation costs and an increasing prevalence with ageing populations.
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