Association between insurance status, anticoagulation quality, and clinical outcomes in patients with acute venous thromboembolism.

Détails

ID Serval
serval:BIB_0F1586A80E44
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Association between insurance status, anticoagulation quality, and clinical outcomes in patients with acute venous thromboembolism.
Périodique
Thrombosis research
Auteur(s)
Zumbrunn B., Stalder O., Méan M., Limacher A., Tritschler T., Rodondi N., Aujesky D.
ISSN
1879-2472 (Electronic)
ISSN-L
0049-3848
Statut éditorial
Publié
Date de publication
01/2019
Peer-reviewed
Oui
Volume
173
Pages
124-130
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
A higher level of health insurance coverage may be related to better quality of care and outcomes. Whether insurance status is associated with anticoagulation quality and clinical outcomes in patients with venous thromboembolism (VTE) is unknown.
We studied 819 elderly patients treated with vitamin K antagonists for VTE in a Swiss prospective multicenter cohort (09/2009-12/2013). The study outcomes were the anticoagulation quality, defined as the time spent in the therapeutic INR range, and clinical events, i.e. the time to a first VTE recurrence, major bleeding, and mortality. We assessed the association between insurance status (private vs. general), anticoagulation quality, and clinical outcomes using regression models, adjusting for potential confounders.
Although the unadjusted mean percentage of time spent in the therapeutic INR range (2.0-3.0) was slightly higher in patients with private vs. general insurance (65% vs. 61%; p = 0.030), the adjusted difference was not statistically significant (1.53%, 95% CI -1.97 to 5.04). Patients with private insurance had a lower 36-month cumulative incidence of major bleeding (9.7% vs. 15.7%; p = 0.018). After adjustment, privately insured patients had a lower risk of major bleeding compared to patients with general insurance (sub-hazard ratio 0.57, 95% CI 0.32 to 0.98). Insurance status was not associated with recurrent VTE or mortality.
Privately insured patients spent somewhat more time in therapeutic INR range and had a lower rate of major bleeding than generally insured patients. Basic (general) health insurance may be a marker of lower anticoagulation quality and higher risk of major bleeding.
Mots-clé
Acute Disease, Aged, Aged, 80 and over, Anticoagulants/adverse effects, Anticoagulants/economics, Anticoagulants/therapeutic use, Female, Hemorrhage/chemically induced, Humans, Insurance Coverage, Insurance, Health, Male, Prospective Studies, Recurrence, Switzerland/epidemiology, Treatment Outcome, Venous Thromboembolism/drug therapy, Venous Thromboembolism/economics, Venous Thromboembolism/epidemiology, Insurance status, Pulmonary embolism, Venous thromboembolism, Venous thrombosis
Pubmed
Web of science
Création de la notice
05/01/2019 17:26
Dernière modification de la notice
20/08/2019 13:35
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