Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study
- 24.04.2024
- Original Research
Erschienen in:
- Verfasst von
- Adenike R. Adelakun
- Mary A. De Vera
- Kim McGrail
- Ricky D. Turgeon
- Arden R. Barry
- Jason G. Andrade
- Jenny MacGillivray
- Marc W. Deyell
- Leanne Kwan
- Doson Chua
- Elaine Lum
- Reginald Smith
- Peter Loewen
- Erschienen in
- Advances in Therapy | Ausgabe 6/2024
Abstract
Introduction
Patients with atrial fibrillation (AF) often switch between oral anticoagulants (OACs). It can be hard to know why a patient has switched outside of a clinical setting. Medication attribute comparisons can suggest benefits. Consensus on terms and definitions is required for inferring OAC switch benefits. The objectives of the study were to generate consensus on a taxonomy of the potential benefits of OAC switching in patients with AF and apply the taxonomy to real-world data.
Methods
Nine expert clinicians (seven clinical pharmacists, two cardiologists) with at least 3 years of clinical and research experience in AF participated in a Delphi process. The experts rated and commented on a proposed taxonomy on the potential benefits of OAC switching. After each Delphi round, ratings were analyzed with the RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness method. Median ratings, disagreement index, and comments were used to modify the taxonomy. The resulting taxonomy from the Delphi process was applied to a cohort of patients with AF who switched OACs in a population-based administrative health dataset from 1996 to 2019 in British Columbia, Canada.
Results
The taxonomy was finalized in two Delphi rounds, reaching consensus on five switch benefit categories: safety, effectiveness, convenience, economic considerations, and drug interactions. Safety benefit (a switch that could lower the risk of adverse drug events) had three subcategories: major bleeding, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding. Effectiveness benefit had four subcategories: stroke and systemic embolism (SSE), ischemic stroke, myocardial infarction (MI), and all-cause mortality. Real-world OAC switches revealed that more OAC switches had convenience (72.6%) and drug interaction (63.0%) benefits compared to effectiveness (SSE 22.0%, ischemic stroke 11.1%, MI 3.1%, all-cause mortality 10.1%), safety (major bleeding 24.3%, GI bleeding 10.6%, ICH 48.5%), and economic benefits (12.1%).
Conclusions
The Delphi-based taxonomy identified five criteria for the beneficial effects of OAC switching, aiding in characterizing real-world OAC switching.
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- Titel
- Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study
- Verfasst von
-
Adenike R. Adelakun
Mary A. De Vera
Kim McGrail
Ricky D. Turgeon
Arden R. Barry
Jason G. Andrade
Jenny MacGillivray
Marc W. Deyell
Leanne Kwan
Doson Chua
Elaine Lum
Reginald Smith
Peter Loewen
- Publikationsdatum
- 24.04.2024
- Verlag
- Springer Healthcare
- Erschienen in
-
Advances in Therapy / Ausgabe 6/2024
Print ISSN: 0741-238X
Elektronische ISSN: 1865-8652 - DOI
- https://doi.org/10.1007/s12325-024-02859-0
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