Impact of multimorbidity and polypharmacy on the management of patients with atrial fibrillation: insights from the BALKAN-AF survey

Kozieł, Monika; Simović, Stefan; Pavlović, Nikola; Kocijančić, Aleksandar; Paparisto, Vilma; Musić, Ljilja; Trendafilova, Elina; Dan, A.; Kušljugić, Zumreta; Dan, Gheorghe‐Andrei; Lip, Gregory Y.H.; Potpara, Tatjana

doi:10.1080/07853890.2020.1799241

Cited by 18 publications

(17 citation statements)

References 35 publications

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“…While an increased risk of falls is a well-known and frequently inappropriate reason to withhold oral anticoagulation in patients with AF, 21 recent registry data demonstrated that multimorbidity and polypharmacy are also common reasons cited for the non-use of oral anticoagulants (OACs). 22 …”

Section: Frail Patients With Atrial Fibrillationmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants in older and frail patients with atrial fibrillation

Giugliano

2022

European Heart Journal Supplements

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Elderly and frail patients with atrial fibrillation (AF) are at increased risk of thrombotic events, bleeding, and death compared to their counterparts, making their management challenging. With the introduction of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) in the past decade, the risk:benefit balance in such high-risk patients with AF has tipped in favor of treating these patients with anticoagulation, and in most cases with a NOAC instead of a VKA. In patients ≥75 years of age with AF, each of the 4 approved NOACs reduced stroke or systemic embolism and vs warfarin in their landmark clinical trial and lowered mortality. However, only apixaban and edoxaban significantly reduced major bleeding vs warfarin. A similar pattern was seen in even older cohorts (≥80 and ≥85 years). Among patients age ≥80 who are not candidates for oral anticoagulants at the approved dose, edoxaban 15 mg may be a reasonable alternative. In elderly or frail individuals who are on multiple comedications (particularly if ≥1 moderate or strong cytochrome P-450 inhibitor), only edoxaban consistently reduced major bleeding compared to warfarin. Regardless of the specific OAC selected, appropriate dosing in the elderly (who frequently qualify for dose reduction per the prescribing label) is critical. In elderly and frail patients with AF, factors that may modify the efficacy-safety profile of specific oral OACs should be carefully considered to permit the optimal selection and dosing in these vulnerable patients.

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Section: Frail Patients With Atrial Fibrillationmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants in older and frail patients with atrial fibrillation

Giugliano

2022

European Heart Journal Supplements

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“…Multimorbidity was defined as ≥2 comorbidities at admission. These cutoffs were based on a similar prior analysis (7). And based on the number of concomitant medications, polypharmacy in our study was defined as ≥5 medications.…”

Section: Patients Selectionmentioning

confidence: 99%

“…These patients have poor survival and higher stroke and bleeding risks compare with AF patients without multimorbidity (5), which poses a significant burden to patients, families, physicians, and global healthcare systems (3). The number of comorbidities directly related to polypharmacy (concomitant use of ≥ 5 medications) (6), and it reported that polypharmacy prevalence in AF has ranged from 40 to 95% (7). The high prevalence of polypharmacy increases further complexity to the management of AF patients.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity and Polypharmacy in Chinese Emergency Department Patients With Atrial Fibrillation and Impacts on Clinical Outcomes

Wang

Yang

Zhu

et al. 2022

Front. Cardiovasc. Med.

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Background and ObjectsFew studies focus on multimorbidity and polypharmacy in Chinese atrial fibrillation (AF) patients. We examined the impact of multimorbidity, polypharmacy, and treatment strategies on outcomes in Chinese emergency department (ED)AF patients. We also assessed factors associated with vitamin K antagonist (VKA) non-use in AF patients with multimorbidity or polypharmacy.Methods2015 AF patients who presented to emergency department (ED) were enrolled from Nov 2008 to Oct 2011, mean follow-up of 12-months. Cox regressions were performed to identify the impact of multimorbidity and polypharmacy on clinical outcomes.ResultsSix hundred and sixty-five patients in low morbidity group (≤1 comorbidity), 608 patients in moderate morbidity group (2 comorbidities), 742 patients in high morbidity group (≥3 comorbidities). Five hundred and seventy patients (28.3%) had polypharmacy (≥5 medications). High and moderate morbidity groups were significantly associated with a higher risk of all-cause death (HR 2.083, 95%CI 1.482–2.929; HR 1.713, 95%CI 1.198–2.449), CV death (HR 2.457, 95%CI 1.526–3.954; HR 1.974, 95%CI 1.206–3.232) and major bleeding (HR 4.126, 95%CI 1.022–16.664; HR 6.142, 95%CI 1.6789–22.369) compared with low morbidity group. In VKA subgroup, only high morbidity group was associated with a higher risk of all-cause death (HR 2.521, 95%CI 1.482–2.929), but not significantly in other events. For polypharmacy category, there were no significant statistics among these endpoints. Coronary artery disease (CAD), hypertension, chronic obstructive pulmonary disease, and antiplatelet therapy were independent predictors for VKA non-use in whole cohort, and patients with multimorbidity. CAD and antiplatelet therapy were independent predictors for VKA non-use in patients with polypharmacy.ConclusionMultimorbidity was associated with worse outcomes in Chinese ED AF patients. Polypharmacy showed no significant statistics among these outcomes. CAD and antiplatelet therapy were independent risk factors of VKA non-use in Chinese ED AF patients with multimorbidity or polypharmacy.

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“…При этом в наблюдательных исследованиях показано, что пациенты с ФП и ОКС реже получают соответствующую антитромботическую терапию [28] и чаще подвержены неблагоприятным исходам [29], чем пациенты с ОКС без ФП. В регистре BALKAN-AF, включавшем 2712 больных ФП, показано, что у коморбидных пациентов с ФП антитромботическая терапия была неоптимальной, и 18% коморбидных пациентов не получали антикоагулянты, при этом наличие ИБС и перенесенного ИМ были независимыми предикторами отсутствия назначения ОАК у коморбидных пациентов с впервые выявленной ФП [30].…”

Section: материал и методыunclassified

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

Lukyanov¹,

Martsevich²,

Andrenko³

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint.

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Impact of multimorbidity and polypharmacy on the management of patients with atrial fibrillation: insights from the BALKAN-AF survey

Cited by 18 publications

References 35 publications

Non-vitamin K antagonist oral anticoagulants in older and frail patients with atrial fibrillation

Non-vitamin K antagonist oral anticoagulants in older and frail patients with atrial fibrillation

Multimorbidity and Polypharmacy in Chinese Emergency Department Patients With Atrial Fibrillation and Impacts on Clinical Outcomes

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

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