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Implementation of Ticagrelor Reduced Mortality in Routine Clinical Care: Evidence From a Natural Experiment Including
Kasper Johannesen1, Jonathan Siverskog1,2,3, Martin Henriksson1
1Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden.
Journal of the American Heart Association
|March 4, 2023
Summary
This study found that using ticagrelor in routine care for myocardial infarction patients in Sweden reduced 12-month mortality. These findings support the effectiveness of ticagrelor shown in clinical trials.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Observational studies on ticagrelor effectiveness in routine care show conflicting results, differing from pivotal trial findings.
- This study addresses the need for reliable effectiveness estimates in real-world clinical settings.
Purpose of the Study:
- To estimate the effect of ticagrelor implementation and use in routine care for myocardial infarction patients.
- To utilize a natural experimental approach to assess ticagrelor's real-world effectiveness.
Main Methods:
- Retrospective cohort study of myocardial infarction patients in Sweden (2009-2015).
- Natural experiment design exploiting variations in ticagrelor implementation timing across treatment centers.
- Assessed 12-month mortality based on admitting center's past ticagrelor use proportion.
Main Results:
- Included 109,955 patients; 30,773 received ticagrelor.
- Higher past ticagrelor use at the admitting center was associated with reduced 12-month mortality (2.5 percentage points).
- Results align with the pivotal ticagrelor randomized controlled trial.
Conclusions:
- Ticagrelor implementation in routine Swedish myocardial infarction care reduced 12-month mortality.
- The study supports the external validity of randomized evidence for ticagrelor effectiveness.
- Real-world data confirms ticagrelor's benefit in acute coronary syndrome management.
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