Use of Antiarrhythmic Medications in Medicare Part D Patients With an Implantable Cardioverter-Defibrillator and Ventricular Tachycardia.
Ventricular tachycardia (VT) is common in cardiomyopathy patients with an implantable cardioverter-defibrillator. This analysis evaluated antiarrhythmic medication use and change in use over time in patients with VT and structural heart disease. Query of Medicare claims identified patients with an implantable cardioverter-defibrillator and VT. Patients with atrial fibrillation or supraventricular tachycardia were excluded. Two cohorts were created of patients enrolled in Medicare Part D for the 12 months before 2007 and 2012. Patients were identified through a search for antiarrhythmic medication fills with a supply covering January 1 of the cohort year. Adjusted logistic regression modeling evaluated the association between patient characteristics and antiarrhythmic medication use. The 2007 (n = 2,334) and 2012 (n = 3,892) Medicare Part D cohorts had similar demographics: median age 76 years, 64%-67% male, and 87%-89% white. Of the 2007 cohort, 1,380 (59%) patients were on a beta blocker, and 484 (20.7%) were on an antiarrhythmic medication (70% amiodarone and 20% sotalol). Between 2007 and 2012, there was a statistically significant higher use of any antiarrhythmic medication (p = 0.014), beta blockers (p <0.0001), mexiletine (p = 0.005), and ranolazine (p <0.0001), while amiodarone use remained unchanged (p = 0.53). After multivariable adjustment, male gender and renal disease were associated with higher antiarrhythmic medication use. In conclusion, although antiarrhythmic medication and beta blocker use in patients with VT increased over time, <1 in 4 patients were on an antiarrhythmic medication and only 65% of the patients were on a beta blocker.
Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: sean.pokorney@duke.edu.
Sean D
SD
Pokorney
Duke Clinical Research Institute, Durham, North Carolina.
Xiaojuan
X
Mi
Duke Clinical Research Institute, Durham, North Carolina.
Bradley G
BG
Hammill
Premier, Inc., Charlotte, North Carolina.
Nancy M
NM
Allen LaPointe
Duke Clinical Research Institute, Durham, North Carolina.
Lesley H
LH
Curtis
Electrophysiology Section, Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Sana M
SM
Al-Khatib
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D; D008801:Mexiletine / Q000627:therapeutic use; D000069458:Ranolazine / Q000627:therapeutic use; D026941:Sodium Channel Blockers / Q000627:therapeutic use; D013015:Sotalol / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014481:United States
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D026941:Sodium Channel Blockers; D008801:Mexiletine; D013015:Sotalol; D000069458:Ranolazine; D000638:Amiodarone