Burden, timing, and relationship of cardiovascular hospitalization to mortality among Medicare beneficiaries with newly diagnosed atrial fibrillation

Turakhia, Mintu P.; Solomon, Matthew D.; Jhaveri, Mehul; Davis, Pamela J.; Eber, Michael; Conrad, Ryan M.; Summers, Nicholas; Lakdawalla, Darius N.

doi:10.1016/j.ahj.2013.07.003

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…ICD-9 codes used to define cardiovascular death and hospitalizations are available in the supplemental material (Supplemental Table 1) and have also been previously detailed. (22)…”

Section: Methodsmentioning

confidence: 99%

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Perino

Fan

Schmitt

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND Atrial fibrillation (AF) occurs in many clinical contexts and is diagnosed and treated by clinicians across many specialties, which has been associated with treatment variation. OBJECTIVES We evaluated the association of treating specialty with AF outcomes among patients with newly-diagnosed AF. METHODS Using complete data of the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study from the Veterans Health Administration, we identified patients with newly diagnosed, nonvalvular AF between 2004-2012 and at least one outpatient encounter with primary care or cardiology within 90 days of AF diagnosis. Cox proportional hazards regression was used to evaluate association between treating specialty and AF outcomes. RESULTS Among 184,161 patients with newly-diagnosed AF (age 70±11; 1.7% women; CHADS-VASc 2.6±1.7), 40% received cardiology care and 60% received primary care only. After adjustment for covariates, cardiology care was associated with reductions in stroke (HR 0.91, 95% CI 0.86-0.96, p <0.001) and death (HR 0.89; 95% CI 0.88-0.91; p <0.0001) and increases in AF/SVT (HR 1.38; 95% CI 1.35-1.42; p <0.0001) and MI (HR 1.03; 95% CI 1.00-1.05; p <0.04). The propensity matched cohort had similar results. In mediation analysis, oral anticoagulation (OAC) prescription within 90 days of diagnosis may have mediated reductions in stroke but did not mediate reductions in survival. CONCLUSIONS In patients with newly-diagnosed AF, cardiology care was associated with improved outcomes, potentially mediated by early OAC prescription. Although hypothesis-generating, these data warrant serious consideration and study of health care system interventions at the time of new AF diagnosis.

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“…ICD-9 codes used to define cardiovascular death and hospitalizations are available in the supplemental material (Supplemental Table 1) and have also been previously detailed. (22)…”

Section: Methodsmentioning

confidence: 99%

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Perino

Fan

Schmitt

et al. 2017

Journal of the American College of Cardiology

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“…Figure 1 illustrates our cohort inclusion criteria: 1) a primary or secondary diagnosis of atrial fibrillation or atrial flutter (International Classification of Diseases, 9th Revision [ICD-9] 427.31 or 427.32) associated with an inpatient or outpatient VA encounter between October 1, 2003 and September 30, 2008 (VA Fiscal Years 2004-2008); 2) a second confirmatory diagnosis between 30 and 365 days after the date of the index AF diagnosis; and 3) at least one primary care, cardiology, women’s health, nephrology, geriatric or anticoagulation clinic outpatient visit in the 90 days on or after the index date; 4) receipt of any outpatient prescriptions within 90 days after the index AF diagnosis. The requirement of a confirmatory AF diagnosis is intended to minimize the impact of rule-out diagnoses and improve specificity; this approach has been previously applied to Medicare (18,19) and VA (12) studies.…”

Section: Methodsmentioning

confidence: 99%

Increased Mortality Associated With Digoxin in Contemporary Patients With Atrial Fibrillation

Turakhia

Santangeli

Winkelmayer

et al. 2014

Journal of the American College of Cardiology

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Objectives To evaluate the association of digoxin with mortality in atrial fibrillation. Background Despite endorsement of digoxin in clinical practice guidelines, there exist limited data on its safety in atrial fibrillation and flutter (AF). Methods Using complete data from the US Department of Veterans Administration (VA) Health Care System, we identified patients with newly-diagnosed, non-valvular AF seen within 90 days in an outpatient setting between VA fiscal years 2004-2008. We used multivariate and propensity-matched Cox proportional hazards to evaluate the association of digoxin use to death. Residual confounding was assessed by sensitivity analysis. Results Of 122,465 patients with 353,168 person-years of follow-up (age 72.1±10.3 years, 98.4% males), 28,679 (23.4%) patients received digoxin. Cumulative mortality rates were higher for digoxin-treated patients than for untreated patients (95 vs. 67 per 1,000 person-years; P<0.001). Digoxin use was independently associated with mortality after multivariate adjustment (HR: 1.26, 95%CI: 1.23-1.29, P<0.001) and propensity matching (HR: 1.21, 95%CI: 1.17-1.25, P<0.001), even after adjustment for drug adherence. The risk of death was not modified by age, sex, heart failure, kidney function, or concomitant use of beta blockers, amiodarone, or warfarin. Conclusion Digoxin was associated with increased risk of death in patients with newly-diagnosed AF, independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies. These findings challenge current cardiovascular society recommendations on use of digoxin in AF.

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“…По результатам исследования RE-LY, спланированного для сравнения двух фиксированных доз дабигатрана с варфарином у пациентов с ФП (средняя оценка по шкале CHADS 2 ОБЗОРЫ § p=0,048), чем в группе больных, принимавших варфарин. Ежегодная частота развития ИМ составила 0,53 % в группе варфарина, 0,72 % -в группе дабигатрана в дозе 110 мг 2 раза в день (p=0,07) и 0,74 % в группе дабигатрана в дозе 150 мг 2 раза в день (p=0,048) [15].…”

Section: обзоры §unclassified

“…ОБЗОРЫ § Н аиболее распространенной аритмией, с которой врач сталкивается в клинической практике, является фибрилляция предсердий (ФП). Известно, что ФП ассоциируется с пятикратным увеличением риска развития инсульта, трехкратным -сердечной недостаточности, двукратным -деменции и смерти [1][2][3]. Согласно данным статистики, распространенность ФП в общей популяции достигает 2 % [4].…”

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Tactics of Selection of Anticoagulant Therapy in Patients With Atrial Fibrillation and Ischemic Heart Disease

Belenkov

Shakaryants

Khabarova

2018

CARDIO

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Резюме В клинической практике лечащий врач нередко теряется в «свободе выбора», предоставляемой ему прямыми пероральными антикоагулянтами. Если пациенту с неклапанной фибрилляцией предсердий показана антикоагулянтная терапия, то какому препарату отдать предпочтение? Какие преимущества получит пациент с ишемической болезнью сердца и фибрилляцией предсердий от назначения определенных прямых пероральных антикоагулянтов и какие риски несет за собой такая терапия? На все эти вопросы в статье даются ответы.

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Burden, timing, and relationship of cardiovascular hospitalization to mortality among Medicare beneficiaries with newly diagnosed atrial fibrillation

Cited by 18 publications

References 26 publications

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Increased Mortality Associated With Digoxin in Contemporary Patients With Atrial Fibrillation

Tactics of Selection of Anticoagulant Therapy in Patients With Atrial Fibrillation and Ischemic Heart Disease

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