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Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study

Adelakun, Adenike R. ; De Vera, Mary A. ; McGrail, Kim ; Turgeon, Ricky D. ; Barry, Arden R. ; Andrade, Jason G. ; MacGillivray, Jenny ; Deyell, Marc W. ; Kwan, Leanne ; Chua, Doson ; Lum, Elaine ; Smith, Reginald ; Loewen, Peter

Advances in therapy, 2024-06, Vol.41 (6), p.2352-2366 [Periódico revisado por pares]

Cheshire: Springer Healthcare

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Título:
Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study
Autor: Adelakun, Adenike R. ; De Vera, Mary A. ; McGrail, Kim ; Turgeon, Ricky D. ; Barry, Arden R. ; Andrade, Jason G. ; MacGillivray, Jenny ; Deyell, Marc W. ; Kwan, Leanne ; Chua, Doson ; Lum, Elaine ; Smith, Reginald ; Loewen, Peter
Assuntos: Administration, Oral ; Aged ; Anticoagulants - administration & dosage ; Anticoagulants - therapeutic use ; Atrial Fibrillation - classification ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Cardiology ; Consensus ; Delphi Technique ; Drug Substitution ; Endocrinology ; Female ; Humans ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Original Research ; Pharmacology/Toxicology ; Rheumatology ; Stroke - etiology ; Stroke - prevention & control
É parte de: Advances in therapy, 2024-06, Vol.41 (6), p.2352-2366
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SourceType-Scholarly Journals-1
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Descrição: 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.
Editor: Cheshire: Springer Healthcare
Idioma: Inglês

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Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study

Adelakun, Adenike R. ; De Vera, Mary A. ; McGrail, Kim ; Turgeon, Ricky D. ; Barry, Arden R. ; Andrade, Jason G. ; MacGillivray, Jenny ; Deyell, Marc W. ; Kwan, Leanne ; Chua, Doson ; Lum, Elaine ; Smith, Reginald ; Loewen, Peter

Cheshire: Springer Healthcare

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