Association of Multimorbidity with Cardiovascular Endpoints and Treatment Effectiveness in Patients 75 Years and Older with Atrial Fibrillation

• Type of Material: Article
• Authors: J’Neka S Claxton, Emory University; Alanna M Chamberlain, Mayo Clinic, Rochester; Pamela L Lutsey, University of Minnesota, Minneapolis; Lin Y Chen, University of Minnesota, Minneapolis; Richard F MacLehose, University of Minnesota, Minneapolis; Lindsay GS Bengtson, Health Economics and Outcomes Research; Alvaro Alonso, Emory University
• Language: English
• Date: 2020-10-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjmed.2020.03.038
• Title of Journal or Parent Work: AMERICAN JOURNAL OF MEDICINE
• Volume: 133
• Issue: 10
• Start Page: E554
• End Page: E567
• Grant/Funding Information: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute and the National Institute on Aging of the National Institutes of Health under Award Numbers R01HL122200, R21AG058445, and K24HL148521. The content is solely the responsibilities of the authors and does not necessarily represent the official views of the National Institutes of Health.; This work was also supported by American Heart Association grant 16EIA26410001.
• Keywords: PREVALENCE; Atrial fibrillation; Science & Technology; Life Sciences & Biomedicine; HOSPITALIZATION; STROKE PREVENTION; ADULTS; Elderly; Cardiovascular disease; CATHETER ABLATION; General & Internal Medicine; Medicine, General & Internal; RISK-FACTORS; ANTICOAGULATION; HEART-FAILURE; MANAGEMENT; VALIDATED METHODS; Multimorbidity

Abstract

Background: The burden imposed by multimorbidity on outcomes and on the effectiveness of atrial fibrillation therapies in elderly adults with atrial fibrillation is unknown. Methods: Patients with nonvalvular atrial fibrillation ages ≥75 years in the MarketScan Medicare Supplemental database from 2007-2015. Prevalence of 14 chronic conditions at the time of atrial fibrillation diagnosis were obtained and classified as cardiometabolic or noncardiometabolic. Cox regression estimated the associations of the number and type of conditions with stroke, severe bleeding, and heart failure hospitalizations. Tests for interaction were assessed between atrial fibrillation treatments and multimorbidity. Results: Among 275,617 patients with atrial fibrillation (mean age 83 years, 51% women), the mean (SD) number of conditions per participant was 3.0 (2.1). Over a mean follow-up of 23 months, 7814 strokes, 13,622 severe bleeds, and 19,252 heart failure events occurred. After adjustment, an increase in the number of cardiometabolic conditions was associated with greater risk of stroke (hazard ratio [HR] 1.07; 95% confidence interval [CI], 1.05-1.10), severe bleeding (HR 1.09; 95% CI, 1.07-1.11), and heart failure (HR 1.19, 95% CI, 1.18-1.20). In contrast, number of noncardiometabolic conditions had weak or null associations with risk of cardiovascular endpoints. Overall, the effectiveness of atrial fibrillation treatment on stroke and heart failure were similar across multimorbidity status, but bleeding risk associated with atrial fibrillation treatments was higher in patients with overall and subgroup multimorbidity. Conclusion: Cardiometabolic multimorbidity was associated with worse outcomes and modified bleeding risk in atrial fibrillation patients. These findings underscore the impact of cardiometabolic conditions on atrial fibrillation outcomes and highlights the need to incorporate multimorbidity management in atrial fibrillation treatment guidelines.