This study investigates trends in mechanical support use after implementation of the Organ Procurement and Transplantation Network’s new heart transplant allocation rules.
Introduction: Previous studies evaluating factors associated with the underuse of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) relied foremost on claims data, which only contains information on prescription fills but not prescriptions written. Thus it remains unclear to the extent to which OAC underuse is due to providers not prescribing OAC versus patients not filling the medication prescribed. Methods: We used Optum’s De-identified Integrated Claims-EHR data, which combined adjudicated claims data with EHR for 24 million patients across the US. We identified patients newly diagnosed with AF between January 2013 and June 2017. The electronic health records (EHR) allowed us to observe the prescriptions ordered by providers, while the claims data provided prescription fill records by patients. We evaluated patient-, provider-, and health plan-related factors associated with under-prescribing of OAC and under-filling after OAC prescribed. Multivariable logistic regression models were constructed to determine factors associated with under-prescribing and under-filling. Results: Of the 6,141 individuals in the study cohort, 51% were not prescribed OAC within six months of their AF diagnosis. Of the 2,956 patients who were prescribed, 19% did not fill it at the pharmacy. ( Figure ) In the final adjusted model, younger age, location (Northeast and South), a low CHA2DS2-VAS score, and a high HAS-BLED score were associated with a lower likelihood of being prescribed OAC. Among patients who were prescribed, Medicare enrollment (OR and 95% CI: 2.2 [1.3, 3.7]) and having a direct oral anticoagulant prescription (OR and 95% CI: 1.5 [1.2, 1.9]) were associated with lower likelihood of filling the prescription. Conclusion: The underuse of OAC among newly diagnosed patients with AF is largely driven by under-prescribing. Our findings support the development of strategies that target improving prescription orders for the underuse of OAC by millions of patients with AF.
As the functions of academia, industry, and government have become increasingly global, so has the field of pharmacoepidemiology. From the perspective of those in the field, the trends in pharmacoepidemiology are remarkably positive, although many important challenges remain. This chapter briefly discusses the future of pharmacoepidemiology from the perspectives of academia, the pharmaceutical industry, regulatory agencies, and then the law. Pharmacoepidemiology can lead to safer use of medications through a better understanding of the factors that alter the risk:benefit balance of medications. The net results of increased activity in pharmacoepidemiology will be better for industry and academia but, most importantly, for the public's health. The next drug disaster cannot be prevented by pharmacoepidemiology. However, pharmacoepidemiology can minimize its adverse public health impact by detecting it early. Hopefully, the next few years will see the utility accentuated and the problems ameliorated.
Funnel plots have been widely used to detect small-study effects in the results of univariate meta-analyses. However, there is no existing visualization tool that is the counterpart of the funnel plot in the multivariate setting. We propose a new visualization method, the galaxy plot, which can simultaneously present the effect sizes of bivariate outcomes and their standard errors in a 2-dimensional space. We illustrate the use of the galaxy plot with 2 case studies, including a meta-analysis of hypertension trials with studies from 1979-1991 (Hypertension. 2005;45(5):907-913) and a meta-analysis of structured telephone support or noninvasive telemonitoring with studies from 1966-2015 (Heart. 2017;103(4):255-257). The galaxy plot is an intuitive visualization tool that can aid in interpreting results of multivariate meta-analysis. It preserves all of the information presented by separate funnel plots for each outcome while elucidating more complex features that may only be revealed by examining the joint distribution of the bivariate outcomes.
Introduction: Electrographic seizures (ES) are an important predictor of neurodevelopmental outcome in neonates undergoing cardiopulmonary bypass (CPB). Following implementation of postoperative co...
