Folkerts, K.

Khoury, H.

Lavoie, L.

Welner, S.

Elsevier - Publisher Connector 

A106  VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 1 - A 2 9 5  
trolled trials (RCTs) evaluating Dabigatran for the treatment of AF. We included stud-
ies that were: (1) a RCT in humans; (2) an investigation of patients with nonvalvular 
atrial fibrillation; (3) an evaluation of dabigatran compared with warfarin or each 
other; and (4) a report of results of stroke or systemic emboli and major bleeding. A 
systematic literature search for dabigatran trials was undertaken for the databases 
Pubmed, Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the 
study size, interventions, year and total bleeding events. For meta-analysis, random 
effects and fixed effects models were used to obtain cumulative statistics. Results: 
Two RCTs with a total of 12,268 patients were identified. The pooled event rate 
for Dabigatran for total bleeding events was 31.9% (95% CI 31%-33%). The pooled 
response rate for Warfarin for total bleeding events was 35.1% (95% CI 34%-37%). The 
cumulative relative risk for total bleeding events with Dabigatran versus Warfarin 
was 0.91 (95% CI 0.89-0.93). ConClusions: Meta-analysis shows Dabigatran has a 
slightly lower rate of total bleeding events compared to Warfarin.
PCV23
Cost And outComes of AntihyPertensiVe treAtments in AsiAn indiAn 
PAtients
Tiwari P.1, Panchal M.1, Kochar A.2
1National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, India,  
2Fortis Heart & Multispeciality Hospital, SAS Nagar, India
objeCtives: The objective of the study was to determine costs and clinical out-
comes of antihypertensive treatment patients taking amlodipine or telmisar-
tan. Methods: This year long prospective observational study was carried out 
at cardiology OPD of a private tertiary health care hospital. The patients over 20 
years of age, either sex, with clinically diagnosed hypertension (JNC VII) receiving 
either telmisartan (40 & 80 mg OD) or amlodipine (5 mg OD or BD) were followed for 
a period of at least 8 weeks after baseline assessment. An attempt made to under-
stand the direct costs involved. The primary outcome measured was difference in 
SBP and DBP after 8 weeks of treatment vs. baseline BP. Only the direct costs were 
included. Results: Of 250 patients studied, 120 belonged to the amlodipine and 
130 to the telmisartan group. 150 had a family history of hypertension. The aver-
age systolic and diastolic BP was 153.90±15.7 and 93.36±7.1 mmHg, respectively. 
Age, weight, height, BMI, Baseline SBP and DBP and duration of hypertension did 
not differ in between amlodipine and telmisartan group. The prevalence of CAD 
was more in male patients; and, the prevalence of diabetes was more in female 
patients. The average reduction in SBP was amlodipine and telmisartan group 
was 17.92±10.2mmHg and 18.48±13.6 mmHg. The average DBP reduction found in 
amlodipine and telmisartan group were 9.45±7.3 and 10.3±6.9 mmHg. However, 
at the end of the minimal follow up period, there was no statistically significant 
difference found in reduction of DBP. BP control was significantly different in 
diabetic and non-diabetic patients. The average cost of drugs per mmHg reduction 
of BP was INR973 and INR812 in amlodipine and telmisartan arms, respectively, 
in non-diabetic hypertensive patients on monotherapy. ConClusions: Despite 
its limitations, the results offer indicative evidence using the real-time Asian 
Indian patients.
PCV25
eVAluAtion of AdherenCe to treAtment Guidelines And re-
hosPitAlizAtion in PAtients With ChroniC heArt fAilure: thAilAnd
Chinwong S., Heamloha R., Triprasertwong W., Chinwong D., Phrommintikul A.
Chiang Mai University, Muang Chiang Mai, Thailand
objeCtives: Current guidelines recommend a combination of ACEIs/ARBs, beta-
blockers and aldosterone antagonists for the treatment of chronic heart disease; 
however, previous studies have found minimal use of these medications. This 
study aimed to evaluate the physicians’ adherence to treatment guidelines and 
to explore the association between adherence to guidelines and re-hospitalization 
in patients with chronic heart failure in Thailand. Methods: This retrospec-
tive cohort study collected data from systolic heart failure patients who received 
treatment from a tertiary university-affiliated hospital between January 2008 and 
December 2010 and were followed-up for 2 years. The evaluation of the physicians’ 
adherence to treatment guidelines in prescribing ACEIs/ARBs, beta-blockers and 
aldosterone antagonists (primary endpoint) were conducted by using a Guideline 
Adherence Indicator (GAI-3; classified as low, medium and high) according to the 
recommendation of guidelines. The secondary endpoint was re-hospitalization for 
CHF during the follow-up period. Results: Of 155 patients, more patients were 
prescribed beta-blockers (65.8%) than ACEIs/ARBs (50.7%) and aldosterone antag-
onists (20.0%). Twenty-five, 47 and 28 percent of patients were classified as low, 
medium and high GAI-3, respectively. The rate of re-hospitalization was lower in 
patients with a high GAI-3 score compared to patients with a medium or low GAI-3 
score (79.1 vs. 90.4 vs. 94.9, per 100 person-years, respectively). Multivariable Cox 
regression analysis (adjusted by sex, age, NYHA Functional Class and comorbidity) 
found that patients with high and medium GAI-3 scores had a lower risk of re-
hospitalization compared with low GAI-3 score (high GAI-3 score:adjusted HR 0.184, 
95%CI:0.093-0.367,p< 0.001; medium GAI-3 score: adjusted HR 0.436, 95%CI:0.238-
0.797,p= 0.007). ConClusions: Physicians’ adherence to treatment guidelines for 
systolic heart failure was not optimal. Some patients did not receive medications 
following the guidelines’ recommendation. Our results suggested that using medi-
cations following treatment guidelines was an important factor to reduce the risk 
of re-hospitalization from heart failure.
PCV26
the use of Pillbox And time in therAPeutiC rAnGe AmonG neW users 
of WArfArin: A ProPeCtiVe Cohort study
Dumas S.1, Rouleau-Mailloux É.2, Bouchama N.1, Lahcene H.1, Tardif J.C.2, Talajic M.2,  
Dubé M.P.2, Perreault S.3
1Université de Montréal, Montreal, QC, Canada, 2Montreal Heart Institute, Beaulieu-Saucier 
Université de Montréal Pharmacogenomics Centre, Montréal, QC, Canada, 3Université de 
Montréal, Montréal, QC, Canada
objeCtives: Warfarin, a widely prescribed oral anticoagulant, is well known to have a 
narrow therapeutic index. Many studies confirmed that adherence helps to achieve a 
stabilization of the INR, but little data is available on the impact of the use of a pillbox. 
The objective of this study is to evaluate the association between the use of a pillbox 
among new warfarin-users and time in therapeutic range (TTR). Methods: This 
study was based on a prospective cohort of new warfarin-users which aims to assess 
the genetic, clinical and environmental risk factors associated with the effectiveness 
and safety of warfarin. Demographic and clinical data were collected among a sub-
group of 702 patients who began the treatment between May 1st, 2010 and Aug. 31st, 
2012 at one of 18 hospitals in Quebec, Canada. Patients were followed-up each three 
months up to a year after the initiation of warfarin. Our outcome was the TTR and 
it was tested using a mixed linear model to allow for repeated measures. Results: 
Mean age was 70.0 ± 11.6, 60.1% were men, 79% had atrial fibrillation as a primary 
indication for warfarin, 67.9% had hypertension and 61.1% had dyslipidemia. Of these 
patients, 47.2%, 53.1%, 56.1% and 60.4% used a pillbox at 3, 6, 9 and 12 months, respec-
tively. Patients who used their own pillbox (approximately 75% of pillbox users) had 
a higher TTR than non-users (3.7%, p= 0.03). These results were adjusted for the INR 
target, age, number of concomitant drugs and patient-reported dose of warfarin as 
these covariates were significantly associated with the outcome. ConClusions: 
There is a significant association between the use of a pillbox prepared by the patient 
and a higher TTR. The use of this device may improve the stability of patients taking 
warfarin, but the clinical significance of this finding is arguable.
PCV27
use of diuretiCs in serbiA from 2008 to 2012
Tomic Z.1, Sabo A.1, Mikov M.1, Milijasevic B.1, Milijasevic D.2, Vukmirovic S.1
1Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Montenegro, 2Faculty of 
Medicine, University of Novi Sad, Serbia, Novi Sad, Serbia and Montenegro
objeCtives: Diuretics are drugs of first choice in the treatment of hypertension. 
The aim of this study was to analyze the consumption of diuretics in Serbia in the 
period from 2008 to 2012 year. Methods: The data about the use of drugs were 
taken from the Agency for Drugs and Medical Devices of the Serbia. Results: The 
use of diuretics during the observed period in Serbia is quite small and it ranged 
from 5 to 6% of the total consumption of all drugs from the C group. Furosemide was 
the most frequently used diuretic from 2008-2010. In the observed period consump-
tion of furosemide ranged about 61 % of the total consumption of all diuretics. On 
the second place in consupmtion during first three years of the study was indapa-
mide. Indapamid records decline in consumption in next two years. In 2011. and 
2012. hydrochlorothiazide takes second place in consumption and marks a possitive 
trend. In 2012. it ranged 7.92 DDD/1000 inh/day. Spironolactone takes the fourth 
position in the first three years. During the 2011. and 2012. consumption of spirono-
lactone has increased and took the third position in consumption. Consumption 
of all other diuretics was small. ConClusions: In Serbia, in the observed period, 
consumption of diuterics were uneven. It is two to three times lower in compari-
son with the consumption of diuretics in Norway and Finland. This research was 
supported by Provincial Secretariat for Science and Technological Development, 
Autonomous Province of Vojvodina project No 114-451-2458/2011 and by Ministry 
of Science, Republic of Serbia, project no 41012.
PCV28
burden of mAjor AdVerse CArdiAC eVents (mACe) in PAtients With 
CoronAry Artery diseAse (CAd) or PeriPherAl ArteriAl diseAse (PAd)
Khoury H.1, Lavoie L.1, Welner S.1, Folkerts K.2
1LASER Analytica, Montreal, QC, Canada, 2Bayer Pharma AG, Wuppertal, Germany
objeCtives: Patients with a history of a cardiovascular (CV) disease are at high risk 
of developing secondary major adverse cardiac events (MACE), including death, non-
fatal myocardial infarction (MI), stroke, symptomatic pulmonary embolism, CV and 
all-cause hospitalization, and bleeding. The objective is to review the epidemiology 
and burden of MACE in patients with coronary artery disease (CAD) or peripheral 
arterial disease (PAD) in Europe, Asia, Latin America and Canada. Methods: A 
comprehensive search was conducted in PubMed, EMBASE, Cochrane and other 
relevant sites. 460 full-text articles, published between 2003 and 2013, were 
reviewed. Results: MACE was more prevalent in CAD/PAD patients compared to 
matched controls (> 2-fold higher). Proportions of CAD patients who have had MI, 
stroke, or bleeding were 1.4%–3.0%, 1.24% and 0.81%, respectively. For PAD patients, 
these proportions were 1.37%–13.7%, 0.4%–5.2%, and 1.3%, respectively. Compared 
to individuals with no CV disease, MACE incidence in CAD or PAD patients was 
increased by at least two-fold, ranging from 18.1%–32.3% for all-cause death, 
12.1%–18.9% for CV death, 8.2%–17.3% for MI and 6.8%–11.3% for stroke. In patients 
with CAD, evidence of MACE was reported within 30 days of primary percutane-
ous coronary intervention and incidence increased over time. The main risk fac-
tors for MACE in CAD/PAD patients included increased oxidative stress in coronary 
and peripheral arteries, diabetes, and chronic kidney disease. Limited information 
was found on the economic and humanistic burden of MACE in CAD/PAD patients. 
Available data showed that MACE occurrence increased hospitalization rates and 
associated costs, in addition to worsening patients’ quality of life. ConClusions: 
Although gaps in the literature were identified, this assessment showed that the 
risk of MACE is substantial among CAD/PAD patients and imposes a considerable 
burden. Development of preventive measures is warranted.
PCV29
rAtes of ACute CoronAry eVents And All CAuse mortAlity in 
PAtients With stAble CoronAry Artery diseAse (CAd) After 
myoCArdiAl infArCtion And AdditionAl CArdioVAsCulAr risk 
fACtors
DeVore S1, Mellstrom C.2, Hunt P.R.3, Kern D.M.4, Tunceli O.4, Wu B.4, Westergaard M.2, 
Hammar N.2
1AstraZeneca, Wilmington, DE, USA, 2AstraZeneca, Mölndal, Sweden, 3Evidera, Lexington, MA, 
USA, 4HealthCore, Inc., Wilmington, DE, USA


PCV28 Burden Of Major Adverse Cardiac Events (Mace) In Patients With Coronary Artery Disease (Cad) Or Peripheral Arterial Disease (Pad) 

file:///data/core-remote/dit/data/elsevier/pdf/e45/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA5ODMwMTUxNDAwNjczMQ==.pdf

PCV28 Burden Of Major Adverse Cardiac Events (Mace) In Patients With Coronary Artery Disease (Cad) Or Peripheral Arterial Disease (Pad)

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector