Concomitant Usage of Contra-Indicated Medications in Patients With Atrial Fibrillation: A Comparison of Real-World Data Sources in the United States
Author(s)
Mike Sicilia, BS, Wouter van der Pluijm, MPH;
Forian, Newtown, PA, USA
Forian, Newtown, PA, USA
Presentation Documents
OBJECTIVES: To understand the difference between closed and open claims when analyzing rates of contra-indicated concomitant medication usage and treatment patterns for Atrial Fibrillation (Afib) in the United States.
METHODS: Forian’s CHRONOSTM was used with data from 2015 to 2024 and open and closed claims were studied independently. Adult patients with at least 2 diagnosis codes for Afib (ICD-10: I48*) at least 3 months apart, at least 1 paid claim for Dofetilide after diagnosis, and continuous enrollment in closed claims or longitudinal history in open claims were selected. Demographic characteristics were summarized descriptively using medians and IQR. Rates of concomitant medication usage with Dofetilide and a contra-indicated medication (Cimetidine, Verapamil, Ketoconazole, Trimethoprim, or Hydrochlorothiazide) were analyzed within 12 months of Dofetilide initiation. Time to first concomitant contra-indicated treatment was analyzed using Kaplan-Maier methods.
RESULTS: In the open claims, 15,342 (56% male, 53% commercial, median age 70 [64 - 76]) patients met the study criteria. Of those patients, 2,731 (18%) had at least 1 paid claim for a concomitant contra-indicated medication. In the closed claims, 7,235 (75% male, 100% commercial, median age 57 [54-62]) patients met the study criteria. Of those patients, 1,011 (14%) had at least 1 paid claim for a concomitant contra-indicated medication. The difference in prevalence was found to be statistically significant (z=7.2165, p<0.001). The most prevalent concomitant medication was Hydrochlorothiazide in both the open (61%) and closed (57%) claims and the median time to concomitancy was 0 days from Dofetilide initiation.
CONCLUSIONS: The analysis shows an example of significant differences in open and closed claims sources when studying the same concomitant contra-indication medication usage. Selecting appropriate datasets is critical to accurately assess treatment patterns, minimize data biases, and ensure findings are relevant for real-world clinical decision-making.
METHODS: Forian’s CHRONOSTM was used with data from 2015 to 2024 and open and closed claims were studied independently. Adult patients with at least 2 diagnosis codes for Afib (ICD-10: I48*) at least 3 months apart, at least 1 paid claim for Dofetilide after diagnosis, and continuous enrollment in closed claims or longitudinal history in open claims were selected. Demographic characteristics were summarized descriptively using medians and IQR. Rates of concomitant medication usage with Dofetilide and a contra-indicated medication (Cimetidine, Verapamil, Ketoconazole, Trimethoprim, or Hydrochlorothiazide) were analyzed within 12 months of Dofetilide initiation. Time to first concomitant contra-indicated treatment was analyzed using Kaplan-Maier methods.
RESULTS: In the open claims, 15,342 (56% male, 53% commercial, median age 70 [64 - 76]) patients met the study criteria. Of those patients, 2,731 (18%) had at least 1 paid claim for a concomitant contra-indicated medication. In the closed claims, 7,235 (75% male, 100% commercial, median age 57 [54-62]) patients met the study criteria. Of those patients, 1,011 (14%) had at least 1 paid claim for a concomitant contra-indicated medication. The difference in prevalence was found to be statistically significant (z=7.2165, p<0.001). The most prevalent concomitant medication was Hydrochlorothiazide in both the open (61%) and closed (57%) claims and the median time to concomitancy was 0 days from Dofetilide initiation.
CONCLUSIONS: The analysis shows an example of significant differences in open and closed claims sources when studying the same concomitant contra-indication medication usage. Selecting appropriate datasets is critical to accurately assess treatment patterns, minimize data biases, and ensure findings are relevant for real-world clinical decision-making.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD58
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems, Reproducibility & Replicability
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)