Coronary Artery DiseaseComparative Effectiveness of Ranolazine Versus Traditional Therapies in Chronic Stable Angina Pectoris and Concomitant Diabetes Mellitus and Impact on Health Care Resource Utilization and Cardiac Interventions
Section snippets
Methods
To compare differences between ranolazine and traditional AA therapies, we conducted a retrospective, quasi-experimental between-group analysis using propensity matching. The data source was the Clinformatics Data Mart representing a commercially available data source for research purposes from United Healthcare's nationwide patient population. The patient population included United Healthcare's fully insured, Medicaid, and Medicare Advantage population representing 49 million unique subjects.
Results
From January 1, 2008, through December 31, 2012, of those meeting the inclusion criteria, 8,008 were identified with CSA receiving either a BB (n = 2,002), CCB (n = 2,002), LAN (n = 2,002), or ranolazine (n = 2,002; Figure 2). As seen in Table 1, baseline characteristics were well matched between groups. Most patients were men, had a mean age of 66 years, and resided within the Southern United States. The type of medical coverage varied between therapeutic treatment groups. For private and
Discussion
As CSA is closely tied to coronary artery disease (CAD) and its complications, this particular CV condition has been associated with a large increase in health care resource utilization. In a post hoc analysis of the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation ACS–Thrombolysis in Myocardial Infarction 36 trial, Arnold et al7 found that compared to those without angina, patients with daily angina after an ACS event had a 2-fold increase in health care resource
Disclosures
Drs. Hartsfield and Koch are employed by Gilead Sciences. None of the other authors have conflicts of interest to disclose.
References (21)
- et al.
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J Am Coll Cardiol
(2012) - et al.
Evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina: results from the TERISA randomized clinical trial (type 2 diabetes evaluation of ranolazine in subjects with chronic stable angina)
J Am Coll Cardiol
(2013) - et al.
Beta-blocker therapy and cardiac events among newly diagnosed coronary heart disease
J Am Coll Cardiol
(2014) - et al.
Costs and clinical outcomes associated with use of ranolazine for treatment of angina
Clin Ther
(2012) - et al.
Impact of ranolazine on clinical outcomes and healthcare resource utilization in patients with refractory angina pectoris
Am J Cardiovasc Drugs
(2013) - et al.
Heart disease and stroke statistics--2015 update: a report from the American Heart Association
Circulation
(2015) - Healthcare Costs and Utilization Project. Chronic condition indicator for ICD-9-cm. Available at:...
- et al.
Measuring concurrent adherence to multiple related medications
Am J Manag Care
(2009) - et al.
Economic impact of angina after an acute coronary syndrome: insights from the MERLIN-TIMI 36 trial
Circ Cardiovasc Qual Outcomes
(2009) - et al.
Effects of ranolazine on exercise tolerance and hba1c in patients with chronic angina and diabetes
Eur Heart J
(2006)
Cited by (9)
Revascularization Rates and Associated Costs in Patients With Stable Ischemic Heart Disease Initiating Ranolazine Versus Traditional Antianginals as Add-on Therapy
2019, American Journal of CardiologyCitation Excerpt :A retrospective analysis of 4,545 unmatched patients with chronic stable angina found that patients with add-on ranolazine were less likely to have a revascularization procedure in the 6 months following index prescription than those with add-on LANs (p <0.001) or those on a BB/CCB combination (p <0.001).11 Similarly, a propensity-matched study of 8,008 patients found that patients on second line BBs or LANs had higher odds (odds ratio, 95% confidence interval) of percutaneous coronary intervention (BB 2.8, 2.2 to 3.5; LAN 2.1 1.7 to 2.6) and coronary artery bypass graft (BB 2.9, 2.0 to 4.1; LAN 2.3, 1.6 to 3.4) within 1 year of treatment initiation compared with those on ranolazine.9 For those on CCBs, the odds of coronary artery bypass graft were comparable (1.3, 0.9 to 2.0) whereas the odds of percutaneous coronary intervention (1.5, 1.2 to 1.9) were significantly higher compared with those on ranolazine.
Ranolazine in patients with type 2 diabetes and chronic angina: A cost-effectiveness analysis and assessment of health-related quality-of-life
2018, International Journal of CardiologyCitation Excerpt :Real-world data has also shown that ranolazine is associated with decreased resource utilization and revascularization in patients with and without diabetes. Page and colleagues used US claims data to conduct a retrospective, quasi-experimental, propensity-matched comparison of patients with chronic stable angina (n = 8008) receiving ranolazine, calcium channel blockers, beta-blockers and long-acting nitrates [27]. Patients on beta-blockers and nitrates had higher rates of all-cause (adjusted incidence rate ratio [aIRR] from 1.16 to 1.32 and 1.10 to 1.33, respectively) and cardiovascular-related healthcare use (aIRR from 1.18 to 1.35 and 1.16 to 1.56, respectively); including outpatient and emergency room visits, inpatient admissions, and length of inpatient stay compared to ranolazine.
Clinical and Economic Outcomes of Ranolazine Versus Conventional Antianginals Users Among Veterans With Chronic Stable Angina Pectoris
2018, American Journal of CardiologyCitation Excerpt :To our knowledge, no randomized controlled trials have directly compared ranolazine with long-acting nitrates in chronic stable angina. However, the results from Page et al offer some support for lower rates of revascularization and utilization outcomes among ranolazine users compared with long-acting nitrate users,13 although lower rates of healthcare utilization were also observed when comparing ranolazine users to β blocker and calcium channel blocker users. The 2012 Stable Ischemic Heart Disease guidelines recommend a β blocker as initial antianginal therapy in patients with Stable Ischemic Heart Disease,2 and that calcium channel blockers, long-acting nitrates, and ranolazine are all acceptable add-on or replacement therapies in patients who are unsuccessful, intolerant, or have contraindications to β blockers.
Antihyperglycemic and Metabolic Effects of Ranolazine in Patients With Diabetes Mellitus
2018, American Journal of CardiologyTargeting endothelial metabolism for anti-angiogenesis therapy: A pharmacological perspective
2017, Vascular PharmacologyCitation Excerpt :Additionally, perhexiline reduces superoxide production in ex vivo aortic rings and ECs [127]. Another CPT1 inhibitor, ranolazine, is approved by the FDA and the European EMEA for treatment of patients with chronic stable angina [128,129], and clinical trials are ongoing to investigate the use of ranolazine for treatment of atrial fibrillation [130–132]. However, most effects of ranolazine point to an effect on myocardial sodium channels, while its inhibitory effect on CPT1-driven FAO has been (largely) overlooked.
Ranolazine: Electrophysiologic Effect, Efficacy, and Safety in Patients with Cardiac Arrhythmias
2016, Cardiac Electrophysiology ClinicsCitation Excerpt :Ranolazine, a piperazine derivative, was initially introduced as an antianginal/anti-ischemic agent.1–8
Funding: The present study was supported by a grant from Gilead Sciences, Foster City, California.
See page 1327 for disclosure information.