Abstract 283: Variation In Ticagrelor Utilization And Outcomes In Patients With Acute Coronary Syndrome
Bibliographic record
Abstract
Background: Ticagrelor is a P2Y12 inhibitor with better cardiovascular outcomes than clopidogrel in clinical trials for acute coronary syndromes. However, the adoption of ticagrelor into clinical practice has been understudied. Therefore, we evaluated: 1) temporal trends in ticagrelor use, 2) factors associated with its use, and 3) hospital variation in its adoption and clinical outcomes. Methods: We conducted a population-based cohort study using administrative claims data in Ontario, Canada between 4/2014 and 3/2018. We identified individuals >65 years of age who were admitted for myocardial infarction (MI) or unstable angina (UA) and filled a prescription for ticagrelor or clopidogrel at or within 7 days of discharge. We categorized hospitals into quartiles based on ticagrelor utilization rates. The primary composite outcome was 1-year death or hospitalization for MI/UA, and 1-year bleeding hospitalization was a secondary outcome. Outcomes were evaluated using a Cox proportional hazards model to compare high vs. low utilization groups. Further, we quantified the between-hospital variability of ticagrelor utilization using multi-level logistic regression analysis, expressed as median odds ratios (MOR). Results: Among 23 962 patients in our cohort, 42.5% were prescribed ticagrelor ≤7 days post-hospital discharge. Ticagrelor utilization increased from 32.6% in 2014 to 51.8% in 2017. Hospitals at the lowest quartile of ticagrelor utilization (<8.8%) had a higher hazard of the primary outcome (adjusted hazard ratio: 1.27 95%CI: 1.11-1.46, p<0.001) compared with high ticagrelor utilization hospitals (>40%). No significant difference in bleeding hospitalization across hospital quartiles was observed. Some factors associated with higher ticagrelor use were cardiologist as most responsible physician during index hospitalization and urban hospital. After adjusting for patient-, prescriber- and hospital-level characteristics, substantial variation remained between hospitals in the likelihood of patients receiving ticagrelor at discharge (MOR: 2.54). Conclusion: Increasing trends of ticagrelor utilization were observed. Ticagrelor utilization rates varied across hospitals, and hospitals with higher ticagrelor adoption were associated with better clinical outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".