Long-Term Relationship Between Atrial Fibrillation, Multimorbidity and Oral Anticoagulant Drug Use

To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes. We used data from the administrative health databases of Lombard...

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Published in:Mayo Clinic proceedings Vol. 94; no. 12; pp. 2427 - 2436
Main Authors: Proietti, Marco, Marzona, Irene, Vannini, Tommaso, Tettamanti, Mauro, Fortino, Ida, Merlino, Luca, Basili, Stefania, Mannucci, Pier Mannuccio, Boriani, Giuseppe, Lip, Gregory Y.H., Roncaglioni, Maria Carla, Nobili, Alessandro
Format: Journal Article
Language:English
Published: England Elsevier Inc 01.12.2019
Frontline Medical Communications Inc
Elsevier Limited
Subjects:
Administration, Oral
Age
Aged
Aged, 80 and over
Analysis
Anticoagulants
Anticoagulants - therapeutic use
Apixaban
Atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - epidemiology
Cardiac arrhythmia
Codes
Cohort Studies
Comorbidity
Disease
Drug Administration Schedule
Drug therapy
Edoxaban
Female
Fibrillation
Hospital patients
Hospitals
Humans
Hypertension
Italy
Male
Middle Aged
Multimorbidity
Online databases
Online health care information services
Patients
Pharmaceutical industry
Population
Prescription drugs
Rivaroxaban
Stroke
Studies
Time Factors
Italy
Germany
OAC
ABC
ICD-9
CV
OR
AF
NOAC
CCI
HR
VKA
ISSN:0025-6196, 1942-5546, 1942-5546
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Summary:To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes. We used data from the administrative health databases of Lombardy. All patients with AF and age 40 years and older and who were admitted to the hospital in 2002 were considered for analysis and followed up to 2014. AF diagnosis and CCI were established according to codes from the International Classification of Diseases, Ninth Revision. In 2002, 24,040 patients were admitted with a diagnosis of AF. CCI was higher in patients with AF than in those without AF (1.8±2.1 vs 0.2±0.9; P<.001). Over 12 years of follow-up, AF was associated with an increased risk of higher CCI (beta coefficient, 1.69; 95% CI, 1.67-1.70). In patients with AF, CCI was inversely associated with OAC prescription at baseline (P<.001) and at the end of the follow-up (P=.03). Patients with AF and a high CCI (≥4) had a higher cumulative incidence of stroke, major bleeding, and all-cause death (all P<.001), compared with those with low CCI (range, 0-3). Adjusted Cox regression analysis revealed that time-dependent continuous CCI was associated with an increased risk for stroke, major bleeding, and all-cause death (all P<.001). In hospitalized patients, AF is associated with an increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI is independently associated with an increased risk of stroke, major bleeding, and all-cause death.
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ISSN:0025-6196
1942-5546
1942-5546
DOI:10.1016/j.mayocp.2019.06.012