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Published on: February 26, 2013
Long-Term Relationship Between Atrial Fibrillation, Multimorbidity and Oral Anticoagulant Drug Use
Marco Proietti1, Irene Marzona2, Tommaso Vannini2
1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Insights
Atrial fibrillation (AF) increases the Charlson Comorbidity Index (CCI), which is linked to fewer oral anticoagulant (OAC) prescriptions. Higher CCI in AF patients independently predicts increased stroke, bleeding, and death risks.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia with significant health implications.
- The Charlson Comorbidity Index (CCI) is a widely used measure of disease burden.
- Understanding the interplay between AF, comorbidities, and treatment is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between atrial fibrillation (AF) and the Charlson Comorbidity Index (CCI).
- To examine the relationship between CCI and oral anticoagulant (OAC) prescriptions in AF patients.
- To assess the impact of CCI on major adverse events in a long-term cohort of AF patients.
Main Methods:
- A population-based cohort study utilizing administrative health databases from Lombardy.
- Inclusion criteria: patients aged 40+ admitted with AF in 2002, followed until 2014.
- AF diagnosis and CCI determined using International Classification of Diseases, Ninth Revision codes.
Main Results:
- AF patients had a significantly higher CCI compared to non-AF patients (1.8±2.1 vs 0.2±0.9).
- Higher CCI in AF patients was inversely associated with OAC prescription rates.
- Elevated CCI (≥4) in AF patients correlated with increased incidence of stroke, major bleeding, and all-cause mortality.
Conclusions:
- Hospitalized AF patients exhibit an increased CCI, which is inversely related to OAC use.
- CCI is an independent predictor of heightened risk for stroke, major bleeding, and all-cause death in AF patients.
Objectives:
To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes.
Patients And Methods:
We used data from the administrative health databases of Lombardy. All patients with AF and age 40 years and older and who were admitted to the hospital in 2002 were considered for analysis and followed up to 2014. AF diagnosis and CCI were established according to codes from the International Classification of Diseases, Ninth Revision.
Results:
In 2002, 24,040 patients were admitted with a diagnosis of AF. CCI was higher in patients with AF than in those without AF (1.8±2.1 vs 0.2±0.9; P<.001). Over 12 years of follow-up, AF was associated with an increased risk of higher CCI (beta coefficient, 1.69; 95% CI, 1.67-1.70). In patients with AF, CCI was inversely associated with OAC prescription at baseline (P<.001) and at the end of the follow-up (P=.03). Patients with AF and a high CCI (≥4) had a higher cumulative incidence of stroke, major bleeding, and all-cause death (all P<.001), compared with those with low CCI (range, 0-3). Adjusted Cox regression analysis revealed that time-dependent continuous CCI was associated with an increased risk for stroke, major bleeding, and all-cause death (all P<.001).
Conclusions:
In hospitalized patients, AF is associated with an increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI is independently associated with an increased risk of stroke, major bleeding, and all-cause death.
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