Panel Members Discuss Burden of NVAF on the Health Care System

Pharmacy TimesNovember 2018 Cough, Cold, & Flu
Volume 84
Issue 11

During a recent panel discussion, 5 pharmacists and physicians raised key points about reducing the cost of managing nonvalvular atrial fibrillation (NVAF).

During a recent panel discussion, 5 pharmacists and physicians raised key points about reducing the cost of managing nonvalvular atrial fibrillation (NVAF). The Peer Exchange, titled “Anticoagulant Management for Nonvalvular Atrial Fibrillation: Burden on Healthcare Systems,” was hosted by Pharmacy Times®.

The Peer Exchange featured a discussion among key opinion leaders about anticoagulation clinics and therapy, novel oral anticoagulants (NOACs), and stroke prevention in NVAF. The panel members were Gary M. Besinque, PharmD, FCSHP; Jaime E. Murillo, MD; Juvairiya Pulicharam, MD; Ralph J. Riello III, PharmD, BCPS; and Peter Salgo, MD.

The discussion began with background information about NVAF, including statistics and goals of treatment. “NVAF accounts for 95% of diagnosed cases of atrial fibrillation (AFib) in the United States,” Salgo said. “NVAF continues to impose a significant resource and cost burden on the United States health care system.

“The treatment goals in NVAF management are to prevent stroke, maintain sinus rhythm, and provide symptomatic relief,” he added.

The panel members discussed some of the biggest concerns with NVAF, including the direct costs of emergency department and office visits, hospitalizations, and readmissions, as well as the indirect costs associated with drugs and adverse events, the increased risk of stroke, and the strong correlation with heart failure.

“That’s probably where the main burden is, the fact that there are consequences associated with atrial fibrillation, not just an isolated event,” Murillo said.

Of the risks associated with AFib, stroke is possibly the most worrisome in terms of preventing financial strain. “If you take a look at the cost burden here, treating AFib is one thing. But once you have a devastating stroke, the cost burden skyrockets…and it’s huge,” Salgo said.

“There are all kinds of rehabilitation. There are all kinds of help that you’re going to need to get through the rest of your life,” Salgo continued. “This is something worth avoiding.”

Anticoagulation therapy is crucial for preventing strokes in patients with AFib. The panel members discussed proper dosing and educating both patients and physicians about the importance of anticoagulants when treating AFib. “Education is very important for patients and primary care physicians. When we did a registry for patients with atrial fibrillation, that’s the 1 thing that stood out,” Pulicharam said.

“Many patients believe that they don’t need anticoagulation. They’re afraid to take any anticoagulation because of bleeding events,” Pulicharam added. “Primary care physicians are also not really sure.”

The panel also discussed the role of pharmacist-led anticoagulation clinics where patients can be closely monitored, the selection of the right anticoagulant, the use of anticoagulant reversal agents, and the use of warfarin compared with NOACs.

For more information about reducing the burden of NVAF on the health care system, using anticoagulants to prevent strokes in NVAF, prescribing the right anticoagulant, and more, watch the Peer Exchange at

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