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Prognostic Importance of Atrial Fibrillation and Anticoagulation in Alcoholic Versus Dilated Cardiomyopathy

Alan Manivannan1, Morten Schou2, Kevin M Monahan2

  • 1Department of Medicine, Section of Internal Medicine, Boston University Medical Center, Boston, MA, USA.

Alcohol and Alcoholism (Oxford, Oxfordshire)
|November 25, 2022
PubMed

Insights

Patients with alcoholic cardiomyopathy (ACM) face a worse prognosis than those with dilated cardiomyopathy (DCM), irrespective of atrial fibrillation (AF). Oral anticoagulation offers similar benefits for both ACM and DCM patients.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pharmacology

Background:

  • Alcoholic cardiomyopathy (ACM) and dilated cardiomyopathy (DCM) are significant heart conditions.
  • Atrial fibrillation (AF) is a common comorbidity in cardiac diseases.
  • Limited data exist on the comparative prognosis of AF and oral anticoagulation in ACM versus DCM.

Purpose of the Study:

  • To compare the prognostic impact of atrial fibrillation (AF) in patients with alcoholic cardiomyopathy (ACM) versus dilated cardiomyopathy (DCM).
  • To assess the effectiveness of oral anticoagulation in patients with ACM compared to DCM.
  • To investigate mortality differences following anticoagulation initiation in both ACM and DCM populations.

Main Methods:

  • A nationwide cohort analysis using Danish registries from 1994-2018.
  • Inclusion of 1237 patients with ACM and 17,211 individuals with DCM.
  • Assessment of prognostic differences and mortality rates with and without AF, and following oral anticoagulation initiation.

Main Results:

  • Patients with ACM were younger, more often male, and had a greater cumulative 5-year mortality than DCM patients, irrespective of AF.
  • The prognosis associated with AF differed significantly between ACM and DCM.
  • Oral anticoagulation demonstrated similar mortality benefits in both ACM and DCM cohorts.

Conclusions:

  • Alcoholic cardiomyopathy (ACM) is associated with a worse prognosis compared to dilated cardiomyopathy (DCM).
  • Atrial fibrillation (AF) does not appear to be the primary driver of the worse prognosis in ACM.
  • Oral anticoagulation provides comparable risk reduction benefits for patients with ACM and DCM.
Abstract

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