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. 2020 Oct;133(10):e554-e567.
doi: 10.1016/j.amjmed.2020.03.038. Epub 2020 Apr 19.

Association of Multimorbidity with Cardiovascular Endpoints and Treatment Effectiveness in Patients 75 Years and Older with Atrial Fibrillation

J'Neka S Claxton  1 , Alanna M Chamberlain  2 , Pamela L Lutsey  3 , Lin Y Chen  4 , Richard F MacLehose  3 , Lindsay G S Bengtson  5 , Alvaro Alonso  6
Affiliations

Association of Multimorbidity with Cardiovascular Endpoints and Treatment Effectiveness in Patients 75 Years and Older with Atrial Fibrillation

J'Neka S Claxton et al. Am J Med. 2020 Oct.

Abstract

Background: The burden imposed by multimorbidity on outcomes and on the effectiveness of atrial fibrillation therapies in elderly adults with atrial fibrillation is unknown.

Methods: Patients with nonvalvular atrial fibrillation ages ≥75 years in the MarketScan Medicare Supplemental database from 2007-2015. Prevalence of 14 chronic conditions at the time of atrial fibrillation diagnosis were obtained and classified as cardiometabolic or noncardiometabolic. Cox regression estimated the associations of the number and type of conditions with stroke, severe bleeding, and heart failure hospitalizations. Tests for interaction were assessed between atrial fibrillation treatments and multimorbidity.

Results: Among 275,617 patients with atrial fibrillation (mean age 83 years, 51% women), the mean (SD) number of conditions per participant was 3.0 (2.1). Over a mean follow-up of 23 months, 7814 strokes, 13,622 severe bleeds, and 19,252 heart failure events occurred. After adjustment, an increase in the number of cardiometabolic conditions was associated with greater risk of stroke (hazard ratio [HR] 1.07; 95% confidence interval [CI], 1.05-1.10), severe bleeding (HR 1.09; 95% CI, 1.07-1.11), and heart failure (HR 1.19, 95% CI, 1.18-1.20). In contrast, number of noncardiometabolic conditions had weak or null associations with risk of cardiovascular endpoints. Overall, the effectiveness of atrial fibrillation treatment on stroke and heart failure were similar across multimorbidity status, but bleeding risk associated with atrial fibrillation treatments was higher in patients with overall and subgroup multimorbidity.

Conclusion: Cardiometabolic multimorbidity was associated with worse outcomes and modified bleeding risk in atrial fibrillation patients. These findings underscore the impact of cardiometabolic conditions on atrial fibrillation outcomes and highlights the need to incorporate multimorbidity management in atrial fibrillation treatment guidelines.

Keywords: Atrial fibrillation; Cardiovascular disease; Elderly; Multimorbidity.

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Conflict of interest statement

All authors have participated in the work and have reviewed and agree with the content of the article. There are no conflicts of interests to report for any of the authors.

References

    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. 2014;64(21):e1–e76. - PubMed
    1. Morillo CA, Banerjee A, Perel P, Wood D, Jouven X. Atrial fibrillation: the current epidemic. J Geriatr Cardiol. 2017;14(3):195–203. - PMC - PubMed
    1. Piccini JP, Hammill BG, Sinner MF, et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ Cardiovasc Qual Outcomes. 2012;5(1):85–93. - PMC - PubMed
    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–2375. - PubMed
    1. Sabbag A, Yao X, Siontis KC, Noseworthy PA. Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges. Korean Circ J. 2018;48(10):873–889. - PMC - PubMed

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