title: A Call for Appropriate Evidence and Outcomes-Based Use and Measurement of Anticoagulation for Atrial Fibrillation: Moving the Population Towards Improved Health Via Multiple Stakeholders.
abstract: A multidimensional approach involving consideration of available resources, individual patient characteristics, patient preferences, and cost of treatment is often required to optimize clinical decision making in the management of atrial fibrillation (AF). In order to bring together varying perspectives on effective tactics and to formulate innovative strategies to improve the management of AF, a think tank consortium of advisors was assembled from across the spectrum of health care stakeholders. Focus groups were conducted and facilitated by a moderator and a notetaker. Participants were asked to comment on preliminary data for the increased prevalence of AF, patterns of treatment, impact of adherence with anticoagulants on clinical and economic outcomes, and opportunities for optimizing treatment.Several recommendations to reach short- and long-term goals in improving AF management emerged from the focus group discussions. These recommendations specifically targeted 3 stakeholder groups--patients/caregivers, physicians, and payers--and addressed the need for better understanding of determinants of undertreatment and nonadherence for those on anticoagulation therapy. Recommendations included the use of real-world data studies to understand regional and demographic patterns of treatment and outcomes, the development of an enhanced national quality standard for anticoagulation, and engaging patients in shared decision making to optimize satisfaction with treatment. Actionable strategies were presented to address gaps related to anticoagulation management. Balancing new anticoagulants' higher prescription costs and safety concerns with their superior effectiveness and convenience of administration for at-risk individuals would require a concerted effort involving patients and their caregivers, physicians, and payers.
authors.affiliation: University of Maryland School of Pharmacy, 220 Arch St., 12th Fl., Rm. 01-204, Baltimore, MD 21201. fshaya@rx.umaryland.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Kountz
authors.forename: Fadia T
authors.initials: FT
authors.lastname: Shaya
authors.forename: Alan H
authors.initials: AH
authors.lastname: Gradman
authors.forename: Gary A
authors.initials: GA
authors.lastname: Puckrein
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kim
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wilbanks
authors.forename: James G
authors.initials: JG
authors.lastname: Stevenson
authors.forename: David L
authors.initials: DL
authors.lastname: Larsen
authors.forename: Michael
authors.initials: M
authors.lastname: Wysong
authors.forename: Viktor
authors.initials: V
authors.lastname: Chirikov
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Pan
authors.forename: Liuo
authors.initials: L
authors.lastname: Xu
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics; D001281:Atrial Fibrillation / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D007349:Insurance, Health, Reimbursement; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care
chemical_list: D000925:Anticoagulants