Association of Multimorbidity with Cardiovascular Endpoints and Treatment Effectiveness in Patients 75 Years and Older with Atrial Fibrillation.
Aged
Aged, 80 and over
Anti-Arrhythmia Agents
/ therapeutic use
Anticoagulants
/ therapeutic use
Arthritis
/ epidemiology
Atrial Fibrillation
/ complications
Coronary Artery Disease
/ epidemiology
Dementia
/ epidemiology
Diabetes Mellitus
/ epidemiology
Female
Heart Failure
/ epidemiology
Hemorrhage
/ epidemiology
Hospitalization
/ statistics & numerical data
Humans
Hyperlipidemias
/ epidemiology
Hypertension
/ epidemiology
Male
Multimorbidity
Neoplasms
/ epidemiology
Proportional Hazards Models
Pulmonary Disease, Chronic Obstructive
/ epidemiology
Renal Insufficiency, Chronic
/ epidemiology
Stroke
/ epidemiology
Treatment Outcome
Atrial fibrillation
Cardiovascular disease
Elderly
Multimorbidity
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
02
01
2020
revised:
09
03
2020
accepted:
09
03
2020
pubmed:
23
4
2020
medline:
24
11
2020
entrez:
23
4
2020
Statut:
ppublish
Résumé
The burden imposed by multimorbidity on outcomes and on the effectiveness of atrial fibrillation therapies in elderly adults with atrial fibrillation is unknown. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32320695
pii: S0002-9343(20)30344-2
doi: 10.1016/j.amjmed.2020.03.038
pmc: PMC8039851
mid: NIHMS1689012
pii:
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Anticoagulants
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e554-e567Subventions
Organisme : American Heart Association-American Stroke Association
ID : 16EIA26410001
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL148521
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL122200
Pays : United States
Organisme : NIA NIH HHS
ID : R21 AG058445
Pays : United States
Informations de copyright
Copyright © 2020. Published by Elsevier Inc.
Références
JACC Clin Electrophysiol. 2016 Apr;2(2):221-229
pubmed: 29766874
PLoS One. 2018 Sep 10;13(9):e0203599
pubmed: 30199542
Clin Geriatr Med. 2016 May;32(2):315-29
pubmed: 27113149
Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):85-93
pubmed: 22235070
J Comorb. 2011 Dec 27;1:28-44
pubmed: 29090134
Medicare Medicaid Res Rev. 2013 Jul 23;3(3):
pubmed: 24753976
Pharmacoepidemiol Drug Saf. 2011 Mar;20(3):313-6
pubmed: 21351314
JAMA. 2001 May 9;285(18):2370-5
pubmed: 11343485
Ther Adv Cardiovasc Dis. 2013 Apr;7(2):53-62
pubmed: 23090783
Heart. 2007 Jan;93(1):35-8
pubmed: 16952972
Am Heart J. 2014 May;167(5):735-42.e2
pubmed: 24766985
J Am Board Fam Med. 2018 Jul-Aug;31(4):503-513
pubmed: 29986975
J Am Heart Assoc. 2017 Jul 23;6(7):
pubmed: 28736385
Am Heart J. 2017 Mar;185:74-84
pubmed: 28267478
Clin Geriatr Med. 2016 May;32(2):399-407
pubmed: 27113155
JAMA. 2012 Jun 20;307(23):2493-4
pubmed: 22797447
Chest. 2010 Nov;138(5):1093-100
pubmed: 20299623
Korean Circ J. 2018 Oct;48(10):873-889
pubmed: 30238705
Mayo Clin Proc. 2014 Oct;89(10):1336-49
pubmed: 25220409
J Geriatr Cardiol. 2017 Mar;14(3):195-203
pubmed: 28592963
Circulation. 2018 Jul 3;138(1):37-47
pubmed: 29490992
Curr Cardiol Rep. 2018 Mar 24;20(5):32
pubmed: 29574524
Vasc Health Risk Manag. 2015 Oct 27;11:555-62
pubmed: 26604772
Prev Chronic Dis. 2013 Apr 25;10:E66
pubmed: 23618546
Eur J Heart Fail. 2013 Aug;15(8):843-9
pubmed: 23594831
Circulation. 2018 Mar 20;137(12):e67-e492
pubmed: 29386200
J Am Coll Cardiol. 2011 Jul 19;58(4):395-401
pubmed: 21757117
Pharmacoepidemiol Drug Saf. 2014 Sep;23(9):891-901
pubmed: 24962929
Heart Rhythm. 2019 Jan;16(1):31-37
pubmed: 30125717
Clin Geriatr Med. 2016 May;32(2):215-26
pubmed: 27113142
Stroke. 1991 Aug;22(8):983-8
pubmed: 1866765
Chest. 2010 Feb;137(2):263-72
pubmed: 19762550
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
pubmed: 24685669
J Am Heart Assoc. 2014 Oct 30;3(6):e001006
pubmed: 25359400