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Published on: February 26, 2013
Atrial fibrillation and comorbidities: Clinical characteristics and antithrombotic treatment in GLORIA-AF
Monika Kozieł1,2, Christine Teutsch3, Jonathan L Halperin4
1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Insights
In patients with atrial fibrillation (AF) and multiple chronic conditions, non-vitamin K antagonist oral anticoagulants (NOACs) were more common than vitamin K antagonists (VKAs). Age, AF type, comorbidities, and kidney function influence OAC prescription.
Area of Science:
- Cardiology
- Pharmacology
- Epidemiology
Background:
- Atrial fibrillation (AF) frequently co-occurs with multimorbidity (≥2 chronic conditions).
- Understanding treatment patterns in these complex patients is crucial for optimizing care.
Purpose of the Study:
- To characterize baseline features and antithrombotic therapy in AF patients with multimorbidity.
- To identify factors influencing oral anticoagulant (OAC) prescription in this population.
Main Methods:
- Analysis of Phase III GLORIA-AF Registry data (January 2014–December 2016).
- Inclusion of recently diagnosed AF patients with CHA2DS2-VASc score ≥1.
- Multivariable log-binomial regression to identify associated factors.
Main Results:
- Over 71% of 21,241 eligible patients had multimorbidity.
- Non-vitamin K antagonist oral anticoagulants (NOACs) were prescribed to 60.2% of multimorbid patients, while vitamin K antagonists (VKAs) were used by 23.6%.
- Factors associated with no OAC included AF pattern, coronary artery disease, prior bleeding, and region; factors associated with OAC prescription included age, BMI, renal function, hypertension, and AF ablation.
Conclusions:
- Multimorbid AF patients receiving NOACs had fewer comorbidities compared to those on VKAs.
- OAC prescription is significantly associated with patient age, AF pattern, comorbidity burden, and renal function.
Background:
Patients with AF often have multimorbidity (the presence of ≥2 concomitant chronic conditions).
Objective:
To describe baseline characteristics, patterns of antithrombotic therapy, and factors associated with oral anticoagulant (OAC) prescription in patients with AF and ≥2 concomitant, chronic, comorbid conditions.
Methods:
Phase III of the GLORIA-AF Registry enrolled consecutive patients from January 2014 through December 2016 with recently diagnosed AF and CHA2DS2-VASc score ≥1 to assess the safety and effectiveness of antithrombotic treatment.
Results:
Of 21,241 eligible patients, 15,119 (71.2%) had ≥2 concomitant, chronic, comorbid conditions. The proportions of patients with multimorbidity receiving non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKA) were 60.2% and 23.6%, respectively. The proportion with paroxysmal AF was 57.0% in the NOAC group and 45.4% in the VKA group. Multivariable log-binomial regression analysis found the following factors were associated with no OAC prescription: pattern of AF (paroxysmal, persistent, or permanent), coronary artery disease, myocardial infarction, prior bleeding, smoking status, and region (Asia, North America, or Europe). Factors associated with OAC prescriptions were age, body mass index, renal function, hypertension, history of cerebral ischemic symptoms, and AF ablation.
Conclusion:
Multimorbid AF patients prescribed NOACs have fewer comorbidities than those prescribed VKAs. Age, AF pattern, comorbidities, and renal function are associated with OAC prescription.
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