The Effect of Multimorbidity and Anticoagulation Use in Patients with Atrial Fibrillation on The One-Year Outcome:...

Patients with atrial fibrillation (AF) frequently have multiple comorbidities that increase the risk of hospitalisation and contribute to higher mortality. However, studies examining the prevalence of comorbidities among Middle Eastern patients with AF and their impact on clinical outcomes are scarce. This study aimed to assess the impact of comorbidities in a Middle Eastern population with AF treated with contemporary anticoagulation.

Prospective observational cohort study.

Patients from 20 hospitals and 30 outpatient cardiology clinics across Jordan were enrolled from May 2019 through October 2020.

2020 consecutive patients were enrolled. 117 of them were lost to follow-up, and 1903 had available data for analysis. Of the total, 1096 (54.3%) patients were women, and 924 (45.7%) were men. Eligible patients were 18 years of age or above, had a confirmed AF diagnosis and provided informed consent.

We are examining the outcomes of patients with AF, comparing those who have multimorbidities versus oligomorbidities. The primary outcomes were AF-related complications occurring within 1-year follow-up: major bleeding, non-major bleeding, stroke/cerebrovascular accidents, systemic emboli and acute coronary syndrome. Secondary outcomes included causes of death among deceased patients.

Among the cohort, 1160 (57.4%) had two or less comorbidities (oligomorbidity group) and 860 (42.6%) had three or more comorbidities (multimorbidity group). Compared with the oligomorbidity group, the multimorbidity group had significantly higher rates of hypertension (97.9% vs 57.2%), diabetes mellitus type II (92.4% vs 7.3%), cardiovascular disease (100% vs 79.6%), chronic kidney disease (18.4% vs 1.8%) and chronic lung disease (7% vs 1%, p<0.001 for all comparisons). Over the 1-year follow-up, the multimorbidity group experienced higher rates of hospitalisation (24% vs 16.9%, p<0.001), all-cause death (21.4% vs 9.5%, p<0.001) and cardiovascular death (11.8% vs 4.7%, p=0.002) than the oligomorbidity group. All-cause mortality in the multimorbid group was mostly related to hypertension with an OR of 5.5 (95% CI 2.07 to 14.73), history of stroke (OR 2.7, 95% CI1.85-4.03) and heart failure (OR 2.3, 95% CI 1.64 to 3.33). However, the use of warfarin (OR 0.6, 95% CI 0.38 to 0.82) and novel oral anticoagulants (OR 0.7, 95% CI 0.46 to 0.91) had protective effects from all-cause mortality.

Middle Eastern patients with AF appear to exhibit a high burden of comorbidities. The results suggest the more comorbidities in these patients, the higher the rates of hospitalisation and death.

NCT03917992.