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Atrial fibrillation (AF) is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce. To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting. AF patients diagnosed between 2007-2015, insured by a large, state-mandated health organization in Israel (Maccabi Healthcare Services) were included. AF was diagnosed based on registered diagnoses. Patients with valvular disease, active malignancy, cardiac surgery ≤ 6 months, or recent pregnancy, were excluded. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated. A total of 15,409 eligible patients (8,288 males, 7,121 females) were identified. Males were more likely to be younger, have higher rates of underlying diseases (ischemic heart disease, heart failure, and chronic obstructive pulmonary disease), but with lower rates of hypertension and chronic kidney diseases as compared to female patients. During the study period, age-adjusted incidence decreased both in men: (-0.020/1,000-person year, p-for trend = 0.033) and, women (-0.025/1,000 person-year p = 0.009). The five-year survival rate was significantly higher among men vs. women (77.1% vs. 71.5%, respectively, p<0.001). Age-adjusted prevalence increased significantly among men (+0.102 per year, p-for trend<0.001) yet decreased among women (-0.082 per year, p-for trend = 0.005). A significant trend toward improved long-term survival was observed in women and not in men. The current study shows significant sex-related disparities in the incidence, prevalence, and survival of AF patients between 2007-2015; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased significantly only in women.

Background/Objectives: While triptans remain the standard of care for moderate-to-severe migraine, the high discontinuation rates and remarkably low prescribing rates of triptans reflect suboptimal therapeutic optimization. Methods: This retrospective cohort study utilized data from Maccabi Healthcare Services (MHS), the second-largest healthcare provider in Israel, spanning 10 years (2012–2022). We identified naïve triptan users aged 21 years or older and evaluated triptan initiation and discontinuation patterns. Median time to discontinuation was assessed using Kaplan-Meier curves. Results: Of 2.8 million MHS members, 91,619 (3.4%) individuals had at least one triptan dispensation or prescription during the study period, including 41,297 triptan-naïve patients who met the study criteria. The median age at triptan initiation was 38.4 years (interquartile range: 28.2–48.0), and 75.6% were female. Overall, the median time to discontinuation was 7.7 months (95% confidence interval: 7.1–8.4). Discontinuation occurred in 70% of the cohort, with approximately 74% of triptan users purchasing only a single triptan formulation throughout the study period. Subgroup analyses by age, sex, socioeconomic status, and anxiety/depression prevalence demonstrated consistent discontinuation patterns across demographic and clinical characteristics, with median time to discontinuation remaining under 12 months in nearly all subgroups. Annual median time to discontinuation consistently remained under 12 months throughout the study period while showing a significant decreasing trend. Conclusions: The low rates of triptan use and high discontinuation rates suggest a possible undertreatment of migraine in Israel. These results highlight the need for improved patient and physician education, and enhanced follow-up protocols.

Introduction Migraine is associated with comorbidities and greater healthcare resource utilization (HCRU). We investigated comorbidity rates and HCRU among Leumit Health Services (LHS) members diagnosed with migraine versus matched controls. Methods This electronic health record (EHR)-based retrospective study included adult LHS members with a migraine diagnosis between 2017 and 2022 (migraine cohort), and matched-controls drawn from the LHS EHR. HCRU was evaluated for 2022. Results The cohorts included 18,527 subjects each (both 78.7% female; mean age, 45.8 ± 14.8 years). Transient ischemic attacks (TIAs), cerebrovascular accidents (CVAs), and valvular disorders were more prevalent in the migraine cohort (TIA, 0.55% vs. 0.30%; CVA, 1.8% vs. 1.3%; valvular disorders, 2.8% vs. 1.8%; all P < 0.001), whereas myocardial infarction was less frequent (1.0% vs. 1.2%; P = 0.015). Hypertension was more prevalent (23.5% vs. 19.9%, P < 0.001), whereas diabetes (10.0% vs. 12.1%, P < 0.001) and chronic kidney disease (0.92% vs. 1.2%, P = 0.028) were less common. All evaluated inflammatory/autoimmune and pain-related/neurological disorders were significantly more prevalent among migraine patients; cancer rates were similar. HCRU was significantly greater among migraine patients, with higher proportions having ≥1 visit to a general practitioner (93.7% vs. 85.4%), neurologist (57.4% vs. 22.1%), pain specialist (12.0% vs. 3.4%), and the emergency department (17.3% vs. 11.2%) (all P < 0.001). Migraine patients were also more likely to request approval for sick days (28.0% vs. 15.7%, P < 0.001). Conclusions Compared to matched controls, migraine was associated with significantly higher rates of multiple comorbidities and substantially increased HCRU, reflecting both clinical and societal burden.

Background Non-Vitamin K antagonist oral anticoagulants (NOACs) emerged as an alternative with comparable or superior efficacy and safety to vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (AF). Objectives The aim of the current study was to investigate the patterns, predictors, timelines and temporal trends of shifting from VKAs to NOACs. Methods In this retrospective observational study, the computerized database of a large healthcare provider in Israel, Maccabi Healthcare Services, was searched to identify patients with AF for whom either a VKA or NOAC was prescribed between 2012 and 2015. Time from diagnosis to therapy initiation and to shifting between therapies was evaluated. Results Out of 6987 eligible AF incident patients, 2338 (33.4%) initiated treatment with a VKA and 2221 (31.7%) with a NOAC. In addition, 5259 prevalent patients were analyzed. During the study period, NOAC prescriptions proportion among the newly diagnosed cases increased from 32 to 68.4% ( p for trend <  0.001). The median time from diagnosis to first dispensing was greater in NOAC than VKA and decreased among patients treated with NOAC during the study period (2012: 1.9 and 0.3 months, 2015: 0.7 and 0.2 months, respectively). During follow-up, 3737 (49%) patients (54.3% and 47.1% of the incident and prevalent cases, respectively), shifted from a VKA to a NOAC, after a median of 22 months and 39 months in the incident and prevalent cases, respectively, decreasing throughout the study period. Female gender, younger age, southern district, higher CHADS 2 and CHA 2 DS 2 -VASC score, non-smoking, and treatment with antiplatelets were associated with a greater likelihood for therapy shift. Shifting from a NOAC to a VKA decreased over time from 8 to 4.5% in 2012 to 0.5% and 0.7% in 2015 in the incident and prevalent groups, p  <  0.001 respectively. Conclusions Shifting from VKA to NOAC occurred in 50% of the cases, more frequently among incident cases, and younger patients with greater stroke risk. Shifting from a NOAC to a VKA was much less frequent, yet it occurred more often in incident cases and decreased over time. A socially and economically sensitive program to optimize the initiation of OAC therapy upon diagnosis is warranted.

Recent international guidelines recommend thromboprophylaxis in patients with cancer at intermediate‐high venous thromboembolism (VTE) risk. We aimed to assess the current incidence, risk factors and management of cancer‐associated VTE and associated health care resource utilization in a 2.5‐million‐member state‐mandated health service in Israel. Patients aged ≥18 years with newly diagnosed cancer, initiating systemic anticancer treatment from 2010 through 2018 were identified from the Israel National Cancer Registry. The index date was fixed as the first day of systemic anticancer treatment. The cumulative VTE incidence from the first day of systemic anticancer treatment and the respective hazard ratios for VTE risk factors were calculated at 12 months of follow‐up. Health care resource utilization (primary care physician, emergency room, and hospital visits) during the study period was compared between patients with and without VTE. A total of 15 388 patients were included, and 338 had VTE with a 12‐month cumulative incidence of 2.2% (95% confidence interval, 1.96%‐2.43%). In a multivariable model, older age, higher comorbidity index, intermediate‐high‐risk Khorana score, certain malignancy types, and chemotherapy were significantly associated with an increased VTE risk in the year after initiating anticancer treatment. Compared with matched controls, the VTE subcohort were more likely to be hospitalized (81.4% vs 35.2%), have longer hospital stays (20.1 days vs 13.1 days), have an emergency room visit (41.5% vs 19.3%), and have a larger number of primary care physician visits (17.6 vs 12.5). Several risk factors, including the Khorana score, were associated with VTE incidence. VTE was associated with long‐term use of anticoagulation. Health care utilization was higher in patients with VTE.

While trends data of osteoarthritis (OA) are accumulating, primarily from Western Europe and the US, a gap persists in the knowledge of OA epidemiology in Middle Eastern populations. This study aimed to explore the prevalence, incidence, correlations, and temporal trends of OA in Israel during 2013–2018, using a nationally representative primary care database. On 31 December 2018, a total of 180,126 OA patients were identified, representing a point prevalence of 115.3 per 1000 persons (95% CI, 114.8–115.8 per 1000 persons). Geographically, OA prevalence was not uniformly distributed, with the Southern and Northern peripheral districts having a higher prevalence than the rest of the Israeli regions. OA incidence increased over time from 7.36 per 1000 persons (95% CI 6.21–7.50 per 1000 persons) in 2013 to 8.23 per 1000 persons (95% CI 8.09–8.38 per 1000 persons) in 2017 (p-value for trend = 0.02). The incidence was lowest in patients under 60 years (in both sexes) and peaked at 60–70 years. In older ages, the incidence leveled off in men and declined in women. The growing risk of OA warrants a greater attention to timely preventive and therapeutic interventions. Further population-based studies in the Middle East are needed to identify modifiable risk factors for timely preventive and therapeutic interventions.

IntroductionThere is limited evidence on the consumption of analgesics in real-world large cohorts of patients with osteoarthritis (OA), especially in those with comorbidities. We aimed to characterize the use of pharmacological analgesic treatments, evaluate standardized comorbidity rates, and assess treatment trends. Our hypotheses were: (1) OA patients generally consume low and inconsistent pharmacological analgesic treatments; (2) analgesic treatment is often non-congruent with comorbidity-related safety concerns. MethodsThe study was carried out at the second largest health maintenance organization in Israel. Members aged 18 years or above who were diagnosed with OA before December 31, 2018, were included. Information was obtained from the members' electronic medical record (EMR) including data on dispensed prescriptions, which were used to estimate analgesic consumption.ResultsA total of 180,126 OA patients were included in our analyses; analgesics were dispensed to 64.2% of the patients, with oral NSAIDs and opioids dispensed to 34.1 and 22.9% of the OA population, respectively. Analgesic use increased with time lapsed from OA diagnosis (p < 0.001), up to a median of 59 days covered (IQR, 20–175) after 21 years. Rates of most comorbidities in the OA population were higher compared to the MHS general population. Patients with comorbidities used more NSAIDs and opioids compared to those without them.ConclusionsMost OA patients use analgesics, usually oral NSAIDs. Analgesic use remains relatively low throughout the years, indicating that many OA patients are not being treated pharmacologically for pain on a regular basis. Despite having higher rates of several comorbidities compared to MHS general population, many OA patients are still treated with analgesics that can be associated with a worsening in comorbidity.Graphic Abstract