Relationship between multimorbidity and outcomes in atrial fibrillation
Por:
Proietti, M, Esteve-Pastor, MA, Rivera-Caravaca, JM, Roldan, V, Rabadan, IR, Muniz, J, Cequier, A, Bertomeu-Martinez, V, Badimon, L, Anguita, M, Lip, GYH, Marin, F, FANTASIIA Study Investigators
Publicada:
1 oct 2021
Ahead of Print:
1 jul 2021
Resumen:
Background: Multimorbidity is common in atrial fibrillation (AF) patients. Charlson comorbidity index (CCI) is used to evaluate multimorbidity in the general population. Limited long-term data are available on the relationship between CCI and AF. We examined the association between CCI, anticoagulation control and outcomes in AF patients. Methods: We studied 1956 from the FANTASIIA registry, an observational Spanish nationwide study on anti coagulated AF patients. Time in therapeutic range (TTR) was used to evaluate anticoagulation control. Stroke/ TIA, major bleeding, cardiovascular (CV) death and all-cause death were study outcomes. Results: Mean +/- SD CCI was 1.1 +/- 1.2. Based on CCI quartiles, patients were categorised in four groups: 676 (34.6%) in Q1 (CCI 0); 683 (34.9%) in Q2 (CCI 1); 345 (17.6%) in Q3 (CCI 2); and 252 (12.9%) in Q4 (CCI >= 3). In vitamin K antagonist treated patients, the highest CCI quartile was inversely associated with TTR >70% (odds ratio:0.67, 95% confidence interval (CI):0.45-0.99). During observation, a progressively higher rate of major bleeding, CV death and all-cause death was found across the quartiles (allp < 0.001). The final Cox multivariable regression analysis showed an association with increasing risk for major bleeding occurrence in Q3 and Q4 (hazard ratio (HR):1.69, 95%CI:1.00-2.87 and HR:1.92, 95%CI:1.08-3.41). An increasing risk for all-cause death and CV death was found across CCI quartiles. Conclusions: In a nationwide contemporary cohort of AF anticoagulated patients, multimorbidity was inversely associated with good anticoagulation control. A progressively higher risk for major bleeding, CV death and all cause death was found across CCI quartiles.
Filiaciones:
Proietti, M:
IRCCS Ist Clin Sci Maugeri, Geriatr Unit, Via Camaldoli 64, I-20138 Milan, Italy
Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy
Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Esteve-Pastor, MA:
Univ Murcia, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Hosp Clin Univ Virgen Arrixaca, Dept Cardiol,CIBERCV, Murcia, Spain
Rivera-Caravaca, JM:
Univ Murcia, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Hosp Clin Univ Virgen Arrixaca, Dept Cardiol,CIBERCV, Murcia, Spain
Roldan, V:
Univ Murcia, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Hosp Univ Morales Meseguer, Dept Hematol & Clin Oncol, Murcia, Spain
Rabadan, IR:
Univ Hosp La Paz, Dept Cardiol, Madrid, Spain
Muniz, J:
Univ A Coruna, Dept Ciencias Salud, Grp Invest Cardiovasc, La Coruna, Spain
CIBERCV, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Cequier, A:
Univ Hosp Bellvitge, Dept Cardiol, CIBERCV, Barcelona, Spain
Bertomeu-Martinez, V:
Univ Hosp San Juan Alicante, Dept Cardiol, Alicante, Spain
Badimon, L:
Cardiovasc Res Ctr CSIC ICCC, Barcelona, Spain
Anguita, M:
Univ Hosp Reina Sofia, Dept Cardiol, Cordoba, Spain
Lip, GYH:
Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Aalborg Univ, Fac Hlth, Dept Clin Med, Aalborg, Denmark
Marin, F:
Univ Murcia, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Hosp Clin Univ Virgen Arrixaca, Dept Cardiol,CIBERCV, Murcia, Spain
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