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

Zumbrunn, Brigitta; Stalder, Odile; Méan, Marie; Limacher, Andreas; Tritschler, Tobias; Rodondi, Nicolas; Aujesky, Drahomir (2019). Association between insurance status, anticoagulation quality, and clinical outcomes in patients with acute venous thromboembolism. Thrombosis research, 173, pp. 124-130. Elsevier 10.1016/j.thromres.2018.11.011

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INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Stalder, Odile; Limacher, Andreas; Tritschler, Tobias; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0049-3848

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

18 Dec 2018 10:43

Last Modified:

11 Feb 2019 12:17

Publisher DOI:

10.1016/j.thromres.2018.11.011

PubMed ID:

30529390

Uncontrolled Keywords:

Aged Insurance status Pulmonary embolism Venous thromboembolism Venous thrombosis

BORIS DOI:

10.7892/boris.122506

URI:

https://boris.unibe.ch/id/eprint/122506

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