Eliquis Has Potential in Impacting Readmission Rates of Pulmonology Patients with Atrial Fibrillation


In Atrial fibrillation (AFib) , Eliquis


By: Saparja Nag  Apr. 26, 2018

Eliquis (apixaban) is primarily prescribed to patients with nonvalvular atrial fibrillation to reduce risk of stroke, as well as to prevent deep vein thrombosis or pulmonary embolisms. Although AFib can occur for a number of different reasons, AFib and reduced pulmonary function are often comorbid. One study from 2009 offered three explanations for the relationship between these two conditions, given below.

  1. Reduced ventilation within the lungs cause ectopic beats within the pulmonary veins that can initiate AFib of the heart
  2. Chronic inflammatory processes, such as those that cause obstructive airway disease, affect the cardiopulmonary system by depositing inflammation-sensitive proteins throughout pulmonary circulation into the left atrium of the heart
  3. AFib causes decreased cardiac output, which subsequently increases the backward pressure and lung congestion; in addition to dilating the atrium, this can hinder lungs' ventilatory processes

In order to study the effects of a relationship between pulmonary function and AFib, Dexur analysts examined the 30-day readmission rates with atrial fibrillation of Medicare inpatients at University Hospital in Augusta, GA. The analysis was initially categorized by surgical status and by department. This study found that non-surgical Medicare inpatients had a higher 30-day AFib readmission rate at 6.20%, whereas surgical patients had a 3.83% readmission rate with AFib. These two rates contributed to a 5.41% overall readmission rate for all Medicare inpatients. By department, cardiovascular Medicare patients had the highest 30-day AFib readmission rate of 7.60%, followed by pulmonology Medicare patients at 6.76%.

Pulmonology DRGsDefinition
DRG-177Respiratory infections and inflammations with major complication or comorbidity
DRG-189Pulmonary edema and respiratory failure
DRG-193Simple pneumonia and pleurisy with major complication or comorbidity
DRG-190Chronic obstructive pulmonary disease with major complication or comorbidity

Dexur analysts then specifically examined common pulmonary conditions at the DRG level to determine their 30-day AFib readmission rates. The conditions covered a wide variety of pulmonary diagnoses from respiratory infections to chronic conditions like COPD (exact definitions are listed above). DRG-177, DRG-189, and DRG-193 each had 30-day readmission rates with AFib higher than any department's rate, as well as the overall inpatient rate; DRG-177 had a readmission rate of 8.24%, DRG-189 of 8.08%, and DRG-193 of 7.85%. DRG-190 patients had a 30-day AFib readmission rate of 5.39%, just around the 5.42% rate for all inpatients. This analysis suggests that a subpopulation of pulmonology patients may be at a higher risk of readmissions due to AFib than the general inpatient population. Eliquis treatment may have value for these patients.

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  1. Discharge volume and 30-day readmission rates by department at University Hospital (Augusta, GA)
  2. Discharge volume and 30-day readmission rates for four pulmonology DRGs at University Hospital (Augusta, GA)

ABOUT THE AUTHOR

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Saparja Nag

Saparja is a healthcare journalist with a particular interest in how medicine can and should affect health policy. She has extensive experience as a health educator and research scientist in biochemistry. She also enjoys running, cooking elaborate meals, and then eating elaborate meals. Saparja received a Bachelors of Arts in Biochemistry from Vassar College.