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Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

Publication ,  Journal Article
Hess, PL; Mirro, MJ; Diener, H-C; Eikelboom, JW; Al-Khatib, SM; Hylek, EM; Bosworth, HB; Gersh, BJ; Singer, DE; Flaker, G; Mega, JL ...
Published in: Am Heart J
September 2014

Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2014

Volume

168

Issue

3

Start / End Page

239 / 247.e1

Location

United States

Related Subject Headings

  • Vitamin K
  • Stroke
  • Risk Assessment
  • Patient Compliance
  • Insurance Coverage
  • Humans
  • Drug Therapy, Combination
  • District of Columbia
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hess, P. L., Mirro, M. J., Diener, H.-C., Eikelboom, J. W., Al-Khatib, S. M., Hylek, E. M., … Atrial Fibrillation Think-Tank Participants, . (2014). Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012. Am Heart J, 168(3), 239-247.e1. https://doi.org/10.1016/j.ahj.2014.04.007
Hess, Paul L., Michael J. Mirro, Hans-Christoph Diener, John W. Eikelboom, Sana M. Al-Khatib, Elaine M. Hylek, Hayden B. Bosworth, et al. “Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.Am Heart J 168, no. 3 (September 2014): 239-247.e1. https://doi.org/10.1016/j.ahj.2014.04.007.
Hess PL, Mirro MJ, Diener H-C, Eikelboom JW, Al-Khatib SM, Hylek EM, et al. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012. Am Heart J. 2014 Sep;168(3):239-247.e1.
Hess, Paul L., et al. “Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.Am Heart J, vol. 168, no. 3, Sept. 2014, pp. 239-247.e1. Pubmed, doi:10.1016/j.ahj.2014.04.007.
Hess PL, Mirro MJ, Diener H-C, Eikelboom JW, Al-Khatib SM, Hylek EM, Bosworth HB, Gersh BJ, Singer DE, Flaker G, Mega JL, Peterson ED, Rumsfeld JS, Steinberg BA, Kakkar AK, Califf RM, Granger CB, Atrial Fibrillation Think-Tank Participants. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012. Am Heart J. 2014 Sep;168(3):239-247.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2014

Volume

168

Issue

3

Start / End Page

239 / 247.e1

Location

United States

Related Subject Headings

  • Vitamin K
  • Stroke
  • Risk Assessment
  • Patient Compliance
  • Insurance Coverage
  • Humans
  • Drug Therapy, Combination
  • District of Columbia
  • Cardiovascular System & Hematology
  • Atrial Fibrillation