Presentación de la ponencia "Eficacia, Efectividad, Eficiencia" por Armando Pérez de Prado en los Diálogos EPIC_Cierre Percutáneo de la Orejuela Izquierda el 15 de Marzo de 2018 en Madrid (España)
18. Situación local: CI a ACO
Cruz González et al. Poster presented at ISPOR 2015
19. Ejemplo local: 10% FAnv = LAAC
Spain
495.998
1,5%
70,0%
yes
70,0%
CHADS2of2orhigher
57,0%
All
100,0%
2.078
60%
40%
0%
40%
20%
40%
10%
35%
15%
40%
SelectCountry
Population
%CHADS2of2orhigher
Percent of AF patients less than 85 years old
Consider only patients less than 85 years old?
Prevalence of Atrial Fibrillation
% of AF that is Nonvalvular AF
CHADS2scoretoconsider
TherapySelection
% getting Warfarin
CurrentTherapyStrategy
Total eligible patients
Warfarin status to consider?
% of warfarin patients to consider
% getting No Therapy/Aspirin
FutureTherapyStrategywithpharmaceuticals&WATCHMAN®
Inputsabovemusttotal100%
Inputs above most total 100%
FutureTherapyStrategywithpharmaceuticalsonly
% getting new OAC
Inputs above must total 100%
% getting Warfarin
% getting Warfarin
% getting new OAC
% getting new OAC
%gettingWATCHMAN®Device
% getting No Therapy/Aspirin
% getting No Therapy/Aspirin
5 años 10 años
21. Ejemplo local: CI / intolerancia a ACO
Spain
495.998
1,5%
70,0%
yes
70,0%
CHADS2of2orhigher
57,0%
Contraindicated & Intolerant
40,0%
831Total eligible patients
Warfarin status to consider?
% of AF patients Contraindicated & Intolerant to warfarin
SelectCountry
Population
%CHADS2of2orhigher
Percent of AF patients less than 85 years old
Consider only patients less than 85 years old?
Prevalence of Atrial Fibrillation
% of AF that is Nonvalvular AF
CHADS2scoretoconsider
10%
90%
Inputs above must total 100%
% getting Warfarin
% getting new OAC
%gettingWATCHMAN®Device
% getting No Therapy/Aspirin
FutureTherapyStrategywithpharmaceuticals&WATCHMAN®
5 años 10 años
23. Perspectiva
Asistencia ventricular como terapia de destino iPCSK9 en HCF HTZ / Enf. aterosclerótica
Kazi et al. JAMA. 2016;316:743Baras et al. JACC: Heart Failure Jan 2017, 555; DOI: 10.1016/j.jchf.2016.09.008
24. Perspectiva
Asistencia ventricular como terapia de destino iPCSK9 en HCF HTZ / Enf. aterosclerótica
ICER / QALY > 200.000$ ICER / QALY > 400.000$
Kazi et al. JAMA. 2016;316:743Baras et al. JACC: Heart Failure Jan 2017, 555; DOI: 10.1016/j.jchf.2016.09.008
25. ¿Qué más necesitamos? Mejor evidencia
• Evaluation of WATCHMAN Left Atrial Appendage
Occlusion Device in Patients With Atrial Fibrillation Versus
Rivaroxaban (NCT02549963)
• PRAGUE-17: Left Atrial Appendage Closure vs. Novel
Anticoagulation Agents in Atrial Fibrillation
(NCT02426944)
• A Pilot Study of Edoxaban in Patients With Non-Valvular
Atrial Fibrillation and Left Atrial Appendage Closure
(NCT03088072)
• Safety and Efficacy of Left Atrial Appendage Closure
Versus Antithrombotic Therapy in Patients With Atrial
Fibrillation Undergoing Drug-Eluting Stent Implantation
Due to Complex Coronary Artery Disease (NCT02606552)
• Prevention of Stroke by Left Atrial Appendage Closure in
Atrial Fibrillation Patients After Intracerebral Hemorrhage
(NCT02830152).
Pérez de Prado et al. Rev Esp Cardiol 2018; doi: 10.1016/j.rec.2017.10.044