Choi, J.C.

Dibonaventura, M.D.

Kopenhafer, L.

Nelson, W.W.

Elsevier - Publisher Connector 

PCV76
PATIENT FACTORS AFFECTING NON-ADHERENCE TO ANTICOAGULATION
THERAPY IN AN INNER-CITY UNDERSERVED MINORITY POPULATION
Bathija S, Schumock GT, Sharp L, Gerber B, Fitzgibbon ML, Cavallari LH, Nutescu E
University of Illinois at Chicago, Chicago, IL, USA
OBJECTIVES: Minority, underserved patients, such as African Americans and His-
panics, are at increased risk of anticoagulation related complications. Evidence
shows that non-adherence has a negative influence on anticoagulation control.
Therefore, the objective of the study was to identify patient factors affecting non-
adherence with anticoagulation therapy in an inner-city, underserved minority
population.METHODS:Weconducted a cross-sectional survey of inner-cityminor-
ity patients who received care at the University of Illinois at Chicago Antithrombo-
sis Clinic. Data on socioeconomic and clinical characteristics, social support and
factors associated with modes of transport to the clinic were collected by using
survey questionnaires and reviewing medical records. Linear regression was per-
formed to identify factors that could be potentially associated with non-adherence
to anticoagulation therapy. RESULTS: A total of 243 African American (n180) and
Hispanic (n63) patients participated in the survey. The mean age was 54.30 
17.49. The majority of the patients were female (72.84%), had an education level of
high school or less (60.44%), an annual income of$15,000 (44.09%), and hadMedi-
care orMedicaid as their primary insurance (77.37%). Themean time in therapeutic
range (TTR) was 49.29  20.89% and mean non-adherence rate with anticoagula-
tion therapy was 12.62  13.81%. Linear regression analysis showed that patients
with missed appointments (p0.01), and Medicare as primary insurance (p0.03)
were more likely to be non-adherent, whereas married patients (p0.01) were less
likely to be non-adherent. CONCLUSIONS: Our findings show that patients are
more likely to be non-adherent with anticoagulation therapy when theymiss their
clinic appointments and have Medicare as their primary insurance. In addition,
marriage as a form of social support decreases the likelihood non-adherence. Fu-
ture research is needed on developing interventions that would target and rein-
force adherence behaviors, help develop self-efficacy and motivation based on
each patient’s lifestyle and social support system.
PCV77
UTILIZATION OF MEDICATIONS FOR SECONDARY PREVENTION OF
CARDIOVASCULAR MORBIDITY AND MORTALITY IN MEDICARE BENEFICIARIES
Olvey EL1, Bootman JL1, Armstrong EP2, Nolan PE1, Sherrill D3, Denninghoff K4,
Skrepnek GH1
1University of Arizona, College of Pharmacy, Tucson, AZ, USA, 2University of Arizona, Tucson,
AZ, USA, 3University of Arizona, Mel & Enid Zuckerman College of Public Health, Tucson, AZ,
USA, 4University of Arizona, Department of Emergency Medicine, Tucson, AZ, USA
OBJECTIVES:To report the utilization of guideline recommended statins, angioten-
sin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and
beta-blockers (BB) for secondary prevention of coronary heart disease (CHD) in
community-dwelling Medicare beneficiaries 65 years. METHODS: Data from the
2004-2006 Medicare Current Beneficiary Survey were utilized to conduct a retro-
spective, cross-sectional study. Community-dwelling Medicare beneficiaries 65
years of age indicating a past history of CHDormyocardial infarctionwere selected.
All commercially available statins, ACEIs/ARBs, and BBs in the US, including brand,
generic and combination products, were included. Medication possession ratio
(MPR) was the proxy used for adherence, defined as 80% MPR. Descriptive statis-
tics were used with sampling weights applied for all analyses. RESULTS: The 2004,
2005 and 2006 sample sizes were 2,338,741, 2,186,251, and 2,159,661, respectively.
At least one prescription medication for statins was reported in 62.2%, 62.4% and
64.0% of beneficiaries in 2004, 2005 and 2006. Adherence in beneficiaries having at
least one prescription for a statin was 44.6% in 2004, 47.4% in 2005, and 54.5% in
2006. In 2004, 2005, and 2006, 59.1%, 55.3%, and 56.5% of beneficiaries reported at
least one prescription for anACEI/ARBwith 45.1%, 40.8%, and 57.2% of beneficiaries
with at least one prescription for an ACEI/ARB achieving80% adherence. At least
one BB prescription was reported for 57.3%, 58.4%, and 61.5% of beneficiaries in
2004, 2005, and 2006, respectively. Adherence to BBs for those beneficiaries report-
ing at least one BB prescriptionwas 35.1%, 44.5%, and 53.6% in 2004, 2005, and 2006,
respectively. The percentage of beneficiaries reporting at least one prescription for
all three medications in 2004, 2005, and 2006 were 27.5%, 26.3% and 29.4%.
CONCLUSIONS:Utilization of guideline recommended pharmacotherapies for sec-
ondary prevention of cardiovascular morbidity and mortality in this US Medicare
patient population have improved over time but remain suboptimal.
PCV78
COMPARING QUALITY OF LIFE IN A MALAYSIAN POST ACUTE CORONARY
SYNDROME POPULATION USING EQ-5D UTILITY TARIFFS FROM DIFFERENT
COUNTRIES
Azmi S1, Anchah L2, Goh A1, Fong A2
1Azmi Burhani Consulting Sdn Bhd, Petaling Jaya, Selangor, Malaysia, 2Sarawak General
Hospital Heart Centre, Kuching, Sarawak, Malaysia
OBJECTIVES: The objective of this research was to examine the differences in
quality of life (QOL) results of Malaysian post-acute coronary syndrome (post ACS)
patients calculated using utility tariffs from different countries. METHODS: This
study utilizes primary data that was collected as part of a study on the cost-effec-
tiveness of a cardiac rehabilitation programme at the Sarawak General Hospital,
Malaysia. QOL of post ACSpatientswere obtained using English andMalay versions
of the EQ-5D questionnaire that have been validated for use in the Malaysian
population. QOL scores were determined using visual analogue scale (VAS) and
calculated using a recently developed Malaysian utility tariff (derived from VAS
valuation of Malaysians) as well as existing EQ-5D tariffs from several other
countries. RESULTS: A total of 112 (female 11.6%, male 88.4%) post-ACS patients
with an average age of 56 (10.38) years answered the EQ-5D questionnaire of which
110 were usable for analysis. The patients had average left ventricular ejection
fraction (LVEF) of 50.2% on admission. Average length-of-stay in hospital and car-
diac care was 6 and 3 days respectively. Mean quality of life was 59.7 on the VAS
score and the mean predicted QOL index score using different tariffs from Malay-
sia, UK (TTO), UK (VAS), Japan (TTO), Korea (TTO), New Zealand (VAS) and US (TTO)
were 0.80, 0.72, 0.72, 0.74, 0.83, 0.68 and 0.79 respectively. CONCLUSIONS: Recent
research argues for the use of locally and culturally appropriate tariffs for different
populations. QOL scores in this sample of post ACS were different when calculated
using utility tariffs from different countries. Our findings suggest that the health
preferences of Malaysians are unique compared to those of other countries and
underscores the importance of applying country specific utility tariffs for QOL and
cost effectiveness studies.
PCV79
SURVEY OF PATIENTS WITH ATRIAL FIBRILLATION ON THE USE OF WARFARI
AND DABIGATRAN
Choi JC1, Dibonaventura MD2, Kopenhafer L2, Nelson WW1
1Janssen Scientific Affairs, LLC, Raritan, NJ, USA, 2Kantar Health, New York, NY, USA
OBJECTIVES: To describe and compare characteristics of AF patients who have
used warfarin or the newer anticoagulant, dabigatran.METHODS: Patient surveys
were conducted via phone or internet from September to November 2011. Study
patients were 18 years old, had a diagnosis of AF, and have used either warfarin
or dabigatran. Characteristics differences were tested using chi-squared and
ANOVA for categorical and continuous variables, respectively. RESULTS: Of those
completed the survey, 204 were warfarin users and 160 were newer anticoagulant
users (NAU). Mean patient age was 65.1. Patients were predominantly male (68.7%)
and non-Hispanic white (91.2%). Nearly half (44.0%) of patients were obese and
more than half (58.0%) had a Charlson Comorbidity Index (CCI) of 1. Average
number of years with an AF diagnosis was 7. Patients were taking 6.26medications
on average. NAUweremore likely to be female (36.9% vs. 27.0%), younger (60.93 vs.
68.36 years), diagnosedmore recently (5.78 vs. 8.10 years), and hadmore education
compared to warfarin patients (all p.05). Levels of obesity (31.9% vs. 53.4%) and
CCI burden of1 (51.9% vs. 62.7%) were lower among NAU (p.05). NAUweremore
likely to use an OTC medication (38.7% vs. 12.1%) or both a prescription and OTC
medication (11.3% vs. 4.3%) to treat stomach-related symptoms (p.05). NAU were
more likely to have had a discussion about their treatment options with their
physicians (36.9% vs. 24.5%) rather than have their physician prescribing (60.6% vs.
73.5%) (p.05). NAU were significantly less likely to have considered switching
theirmedication (10.7% vs. 31.9%). Among those considered switching, cost (62.5%)
was the most common reason for NAU, and inconvenience factors for warfarin
users. CONCLUSIONS: There were some characteristic differences among AF pa-
tients. Understanding patients’ characteristics may be the first step in helping
patients to be adherent to their stroke prevention medications.
PCV80
THE DEVELOPMENT AND VALUATION OF THE SHEFFIELD PREFERENCE BASED
LEG ULCER QUESTIONNAIRE (SPVU-5D)
Palfreyman S1, Brazier J2
1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, 2University of Sheffield,
Sheffield, South Yorkshire, UK
OBJECTIVES: To describe the development of the Sheffield Preference-based Leg
Ulcer patient questionnaire (SPVU-5D) and value the resulting health states.
METHODS: Patient and clinician interviews (n31) were used to identify items for
inclusion. The psychometric performance of the items in the draft descriptive
system were evaluated through a postal survey of venous ulcer patients (n266).
Factor and Rasch analysis were used to guide the choice of the final items. Prefer-
enceweights for the final five item instrumentwere obtained through a time trade-
off (TTO) valuation of a representative sample of theUK general population (n160)
using regressionmodels incorporating individual level data. RESULTS:A total of 16
items were identified for inclusion. A response rate of 59% was obtained from the
postal survey (n156). Four items were excluded due to poor completion rates or
floor/ ceiling effects. Factor analysis using promax rotation showed a two factor
solution with Cronbach’s alpha coefficient of 0.91 for 0.92. Rasch analysis showed
six disordered items, which had item levels merged and the model refitted. The
final descriptive system consisted of five items with between three and five levels.
A fractional factorial design was employed to select 25 health states from the 720
defined by the final instrument. Predicted health state values were calculated and
compared to the actual values derived from the TTO valuation. The best perform-
ing model (OLS model) predicted 25 out of the 26 health states valued in the TT0 to
within 0.1, and the predicted valuewithin 0.03, 69% of the time andwithin 0.05 92%
of the time. The mean absolute error was 0.02. CONCLUSIONS: A bottom-up ap-
proach was used to design SPVU-5D. It is the only existing PRO which has utility
values assigned to the health states it describes and so can be used within eco-
nomic analysis of interventions for venous ulceration.
PCV81
IMPACT OF THE AWARENESS OF CARDIOVASCULAR DISEASE (CVD) RISK ON
THE MANAGEMENT IN HYPERTENSIVE PATIENT IN KOREA
Jeong MH1, Kim DS2, Chang HJ3, Park SW4, Hong GR5, Kim YJ6
1Chonnam National University Hospital, Gwangju, South Korea, 2Inje University Pusan Paik
Hospital, Busan, South Korea, 3Sevrance Hospital, Yonsei University, Seoul, South Korea,
4Samsung Medical Center, Seoul, South Korea, 5Yeungnam University Medical Center, Daegu,
South Korea, 6Pfizer Pharmaceuticals Korea Limited, Seoul, South Korea
OBJECTIVES: According to current guidelines for the primary prevention of cardio-
vascular disease (CVD), early risk stratificationmight be critical to planning appro-
A126 V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 1 – A 2 5 6


PCV79 Survey of Patients with Atrial Fibrillation on the Use of Warfari and Dabigatran 

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PCV79 Survey of Patients with Atrial Fibrillation on the Use of Warfari and Dabigatran

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