For the estimated 5 million people in the United States with atrial fibrillation, several treatment approaches can be utilized, each with a wide range of available pharmacological options. The AHA/ACCF/HRS guidelines recommend the implementation of rate control therapy to control heart rate, plus rhythm control treatment to establish a normal sinus rhythm for appropriate patients. The use of rate and/or rhythm control is usually accompanied by antithrombotic therapy for stroke risk reduction in at-risk patients. Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in newly diagnosed and recently treated AF populations. Concerning newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and patient share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. With respect to recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliancy by brand. This report is delivered as a key findings slide deck and a companion downloadable Excel file. It presents claims that are 6-12 months old at the time of publication.

Questions Answered:

  • Newly diagnosed patients: AF patients typically began treatment with a key therapy within six months of first diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?
  • Recently treated patients: Consistent with historical treatment patterns, beta blockers continue to capture the majority of recently treated patient prescriptions. Which specific drugs garner the most patient share for recently treated AF patients? When do patients progress from one therapy to the next in AF, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?
  • Pathways to key therapies: Excluding anticoagulants, longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for AF?

Scope:

  • Markets covered: United States
  • Methodology: Analysis of patient-level claims data extracted from DRG’s Real-World Database that provides a large and representative sample of U.S. treatment practice of the Medicare supplemental and commercially insured populations. Study follows newly diagnosed U.S. atrial fibrillation patients 730 days after diagnosis to explore progression through early treatment; the report captures a cohort of AF patients treated with key brands in the previous 6 months.
  • Indication coverage: Atrial fibrillation
  • Key drugs covered: Pradaxa, Xarelto, Eliquis, Savaysa, Multaq, warfarin, metoprolol, amiodarone, diltiazem, etc.