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Prognosis of Atrial Fibrillation with or without Comorbidities: Analysis of Younger Adults from a Nationwide Database.

ABSTRACT: To assess the prognosis of AF patients with or without cardiac or extra-cardiac concomitant conditions. All consecutive patients diagnosed with AF admitted to French hospitals between 2011 and 2020 were identified. Patients were classified into four groups: (1) > 60 yo; (2) with known cardiac disease (KCD group); (3) with extra-cardiac comorbidities (ECC); and 4) AF without KCD or ECC ("Lone AF"). Altogether 2,435,541 patients were identified, from which 2,203,702 patients aged >60 years and 231,839 patients aged <60 years (with KCD (55.2%), with ECC (14.7%) and with "Lone AF" (30.1%)). During follow-up, the incidences of all-cause and CV deaths were 13.7%, 5.7%, 6.2%, and 2.3%, and 4.2%, 1.7%, 0.8%, and 0.3% in the older than 60 yo group, KCD group, ECC group and "Lone AF" AF group, respectively. In the age and sex-adjusted analysis (patients < 60 yo), patients with AF and KCD had worse outcomes than patients with "Lone AF" for all major cardiac events. There are three distinct prognostic criteria based on the presence or lack of HD or extra-cardiac concomitant comorbidities. Patients in the so-called "Lone AF" group remain severe in terms of CV events but still with a lower incidence than the patients with associated KCD or ECC. The presence of KCD or ECC makes it possible to distinguish a profile in terms of events that are very different between the patients.

SUBMITTER: Mertz V

PROVIDER: S-EPMC8999868 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Prognosis of Atrial Fibrillation with or without Comorbidities: Analysis of Younger Adults from a Nationwide Database.

Mertz Valentin V Cottin Yves Y Bentounes Sid Ahmed SA Pastier-Debeaumarché Julie J Didier Romain R Herbert Julien J Zeller Marianne M Lip Gregory Y H GYH Fauchier Laurent L

Journal of clinical medicine 20220401 7

Objective: To assess the prognosis of AF patients with or without cardiac or extra-cardiac concomitant conditions. Participants and Methods: All consecutive patients diagnosed with AF admitted to French hospitals between 2011 and 2020 were identified. Patients were classified into four groups: (1) > 60 yo; (2) with known cardiac disease (KCD group); (3) with extra-cardiac comorbidities (ECC); and 4) AF without KCD or ECC (“Lone AF”). Results: Altogether 2,435,541 patients were identified, from w ...[more]

PMID: 35407589

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Project description:OBJECTIVES:We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant. DESIGN AND SETTING:Retrospective cohort study based on Danish nationwide registries. PARTICIPANTS:Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF. PRIMARY AND SECONDARY OUTCOMES:The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis. RESULTS:The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy. CONCLUSIONS:In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.

Project description:ObjectiveNon-vitamin K antagonist oral anticoagulants (NOACs) are proven alternatives to warfarin for preventing stroke in patients with non-valvular atrial fibrillation. We aimed to examine the treatment patterns and patient factors associated with the use of antiplatelet agents, warfarin, and NOACs in clinical practice.MethodsWe conducted a retrospective cohort study using the Korean Health Insurance Review & Assessment Service database. Patients receiving antithrombotics were identified before and after the introduction of NOACs (from August 1, 2013 to December 30, 2014 and July 1, 2015 to November 30, 2016, respectively). Patients were included if they were aged ≥18 years, had an atrial fibrillation diagnosis, and had a CHA2DS2-VASc score ≥2. Treatment pattern was assessed by classifying patients into NOAC, warfarin, or antiplatelet users based on the first date of antithrombotic prescription. Clinical factors associated with the type of antithrombotics chosen were examined using logistic regression analyses.ResultsWe identified 129,465 and 196,243 patients before and after the introduction of NOACs, respectively. The proportion of antiplatelet users was 60.7 and 53.0% before and after the introduction of NOACs, respectively. The proportion of warfarin users was higher in patients with low HAS-BLED score, high CHA2DS2-VASc score, or stroke before the NOAC era. A similar trend was observed for NOAC and warfarin users after the introduction of NOAC. Compared with antiplatelets, warfarin and NOAC uses were significantly associated with CHA2DS2-VASc score and stroke, whereas presence of myocardial infarction (MI) and peripheral arterial disease were significantly associated with antiplatelets prescription. For comparisons between NOAC and warfarin, HAS-BLED and CHA2DS2-VASc scores showed significant associations with NOAC use, whereas comorbidities including MI were significantly associated with warfarin use.ConclusionsThe treatment pattern of antithrombotics did not change with the introduction of NOACs. However, comorbidities served as an important factor in choosing treatment regardless of NOAC entry.

Project description:Introduction A paucity of contemporary data examining bleeding-related hospitalization outcomes in atrial fibrillation (AF) patients exists. Methods Adults in the Nationwide Readmissions Database (January 2016-November 2016) with AF and hospitalized for intracranial hemorrhage (ICH), gastrointestinal, genitourinary, or other bleeding were identified. Association between bleed types and outcomes were assessed using multivariable regression (gastrointestinal defined as referent) and reported as crude incidences and adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CIs). Results In total, 196,878 index bleeding-related hospitalizations were identified in this AF cohort (CHA2DS2VASc score ≥2 in 95.1%), with 70.8% classified as gastrointestinal. The overall incidences of in-hospital mortality, need for post-discharge out-of-home care, and 30-day readmission were 4.9, 50.8, and 18.2%, respectively. Multivariable regression suggested traumatic and nontraumatic ICHs were associated with higher odds of in-hospital mortality (OR = 3.99, 95% CI = 3.79, 4.19; OR = 13.09, 95% CI = 12.24, 13.99) and need for post-discharge out-of-home care (OR = 2.92, 95% CI = 2.83, 3.01; OR = 2.74, 95% CI = 2.59, 2.90), and increases in mean index hospitalization length-of-stay (8.31 days, 95% CI = 8.03, 8.60, 6.27 days, 95% CI = 5.97, 6.57) versus gastrointestinal bleeding. Genitourinary and other bleeds were associated with lower mortality (OR = 0.37, 95% CI = 0.25, 0.55; OR = 0.59, 95% CI = 0.53, 0.64) and reduced length-of-stays (-2.84 days, 95% CI = - 2.91, -2.76; -2.06 days, 95% CI = - 2.11, -2.01) versus gastrointestinal bleeding. Genitourinary bleeds were also associated with a reduced need for post-discharge out-of-home care (OR = 0.86, 95% CI = 0.77, 0.97). Conclusion The burden of bleeding-related hospitalizations was notably driven by relatively rare but severe and life-threatening ICH, and less morbid but more frequent gastrointestinal bleeding. There is need for continued research on bleeding risk factors and mitigation techniques to avoid bleeding-related patient hospitalizations.

Project description:BackgroundClinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidities influence management and prognosis of patients with atrial fibrillation (AF). We aimed to identify phenotypes of AF patients according to comorbidities and to assess associations between comorbidity patterns, drug use and risk of major outcomes.MethodsFrom the prospective GLORIA-AF Registry, we performed a latent class analysis based on 18 diseases, encompassing cardiovascular, metabolic, respiratory and other conditions; we then analysed the association between phenotypes of patients and (i) treatments received and (ii) the risk of major outcomes. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Secondary exploratory outcomes were also analysed.Results32,560 AF patients (mean age 70.0 ± 10.5 years, 45.4% females) were included. We identified 6 phenotypes: (i) low complexity (39.2% of patients); (ii) cardiovascular (CV) risk factors (28.2%); (iii) atherosclerotic (10.2%); (iv) thromboembolic (8.1%); (v) cardiometabolic (7.6%) and (vi) high complexity (6.6%). Higher use of oral anticoagulants was found in more complex groups, with highest magnitude observed for the cardiometabolic and high complexity phenotypes (odds ratio and 95% confidence interval CI): 1.76 [1.49-2.09] and 1.57 [1.35-1.81], respectively); similar results were observed for beta-blockers and verapamil or diltiazem. We found higher risk of the primary outcome in all phenotypes, except the CV risk factor one, with highest risk observed for the cardiometabolic and high complexity groups (hazard ratio and 95%CI: 1.37 [1.13-1.67] and 1.47 [1.24-1.75], respectively).ConclusionsComorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.

Dataset Information

Prognosis of Atrial Fibrillation with or without Comorbidities: Analysis of Younger Adults from a Nationwide Database.

Publications

Prognosis of Atrial Fibrillation with or without Comorbidities: Analysis of Younger Adults from a Nationwide Database.

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