Cardiovascular medications used for comorbid diseases in patients with atrial fibrillation. The JoFib study
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Published on: February 26, 2013
Nasr Alrabadi1, Mohammed Al-Nusair2, Razan Haddad3
1Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan. nnalrabadi@just.edu.jo.
Insights
Cardiovascular medications like ACE inhibitors/ARBs and statins show protective effects in atrial fibrillation (AF) patients, reducing mortality and bleeding risks. These drugs should be considered for AF patients when clinically indicated.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Atrial fibrillation (AF) patients often use cardiovascular medications for non-AF related conditions.
- These non-AF medications can influence patient morbidity and mortality outcomes.
- Understanding medication use patterns is crucial for managing AF patient care.
Purpose of the Study:
- To investigate the characteristics of AF patients using various non-AF cardiovascular medication classes.
- To analyze the clinical course and outcomes associated with different non-AF medication regimens in AF patients.
Main Methods:
- Prospective, multicenter registry data from the JoFib study was utilized.
- Identified and categorized non-AF medications (excluding rate/rhythm control and anticoagulation).
- Demographic, clinical characteristics, and AF-related outcomes were assessed.
Main Results:
- Five non-AF medication classes were identified: aspirin, P2Y12 inhibitors, ACE inhibitors/ARBs, statins, and diuretics.
- Diuretics and ACE inhibitors/ARBs were most common (39.2% and 39%).
- ACE inhibitor/ARB therapy reduced all-cause and cardiovascular mortality (aHR 0.50, 0.51). Statin therapy reduced cardiovascular mortality (aHR 0.68) and clinically relevant non-major bleeding (OR 0.62).
Conclusions:
- ACE inhibitors/ARBs and statins demonstrate protective effects in AF patients.
- These medications are associated with reduced mortality and bleeding events.
- Further research is warranted to explore routine use of these beneficial medications in AF patients.
Purpose:
Many atrial fibrillation (AF) patients use cardiovascular medications for indications other than AF. These medications can affect morbidity and mortality. We aim to investigate the characteristics of AF patients who use different medication classes and their clinical course.
Methods:
We collected data from the prospective, multicenter registry, JoFib study. We identified classes of non-AF medications (medications not used for rate control, rhythm control, or anticoagulation), described demographic and clinical characteristics, and investigated AF-related outcomes according to these medication classes.
Results:
From a total of 2020 patients, five classes of cardiovascular non-AF medications were identified, aspirin, P2Y12 inhibitors, ACE inhibitors/ARBs, statins, and diuretics. The most commonly used non-AF medications were diuretics and ACE inhibitors/ARBs (39.2%, and 39%, respectively). 51% of AF patients took more than one non-AF medication. Multivariable Cox regression analysis demonstrated that ACE inhibitor/ARB therapy independently reduced the risks of all-cause mortality and cardiovascular mortality (aHR 0.50, 95%CI 0.37-0.68; aHR 0.51, 95%CI 0.34-0.75, respectively) and that statin therapy reduced the risk of cardiovascular mortality (aHR 0.68, 95%CI 0.48-0.98) in AF patients. Multivariable logistic regression analysis demonstrated a protective effect of statin therapy against the secondary outcome, clinically relevant non-major bleeding (CRNMB) (adjusted OR 0.62 95%CI 0.42-0.94).
Conclusion:
Our findings suggest a protective effect of ACE inhibitors/ARBs against all-cause and cardiovascular mortality, statins against cardiovascular mortality, and CRNMB in patients with AF. Accordingly, these medications should be encouraged in patients with AF when indicated. Additionally, future research should explore whether these medications should be offered to AF patients more routinely. The study was registered with Clinicaltrials.gov (unique identifier number: NCT03917992, Registration date:14/4/2019).
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