NCDR Study Shows Increasing Ticagrelor Use With Hospital, Patient Variations

Use of the P2Y12 inhibitor ticagrelor has steadily increased since its 2011 approval by the U.S. Food and Drug Administration, with variations based on patient- and hospital-level characteristics, according to a study published Jan. 15 in the International Journal of Cardiology.

Benjamin A. Rodwin, MD, et al., reviewed data from ACC's Chest Pain – MI Registry to describe trends in the use of the P2Y12 inhibitors clopidogrel, ticagrelor and prasugrel among 362,354 myocardial infarction (MI) patients treated at 801 hospitals from 2009 through 2017. The researchers looked at patient- and hospital-level characteristics with associated medication choice, compared patient case mix among hospitals with higher vs. lower uptake of ticagrelor, and examined variation in ticagrelor use among hospitals over time.

During the study period, overall use of ticagrelor increased from 6.1% to 33.7%, with corresponding decreases in use of clopidogrel (73.1% to 55.2%) and prasugrel (20.8% to 11.1%). Patients who were prescribed either prasugrel or ticagrelor were more likely to have private insurance and present with STEMI but were less likely to have a history of prior MI, diabetes, hypertension or dyslipidemia. Patients who presented with STEMI, received treatment in the northeastern U.S. and were white were most likely to receive ticagrelor.

In addition, the researchers divided the hospitals into quartiles based on ticagrelor uptake. They found that facilities in the highest quartile had ticagrelor use rates of 29.4% to 88.4%, while rates in the lowest quartile ranged from 0% to 8.2%. Higher-uptake hospitals were more likely to be in the northeast and have lower annual volumes of STEMI and NSTEMI patients. Hospital-level rates of ticagrelor use at the time of discharge increased over time, from a median of 5% to 25%.  

According to the researchers, the study shows "rapid rise in the use of ticagrelor" and offers "important insight" for determining patient- and hospital-level characteristics associated with adoption of new treatments. They conclude that moving forward, their findings "could represent foundational research for future quality improvement initiatives aimed at incorporating the latest evidence into routine clinical practice."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertension

Keywords: Registries, National Cardiovascular Data Registries, Myocardial Infarction, Chest Pain, Chest Pain MI Registry, Diabetes Mellitus, Hypertension, Dyslipidemias

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