Karen P Alexander1, Marc A Brouwer2, Hillary Mulder3, Dragos Vinereanu4, Renato D Lopes3, Marco Proietti5, Sana M Al-Khatib3, Ziad Hijazi6, Sigrun Halvorsen7, Elaine M Hylek8, Freek W A Verheugt9, John H Alexander3, Lars Wallentin6, Christopher B Granger3. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: karen.alexander@duke.edu. 2. Radboud University Medical Center, Nijmegen, The Netherlands. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 4. University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania. 5. Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy. 6. Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 7. Oslo University Hospital, Oslo, Norway. 8. Boston University Medical Center, Boston, MA. 9. University Medical Centre of Nijmegen, Nijmegen, Netherlands.
Abstract
BACKGROUND: Patients with atrial fibrillation (AF) often have multi-morbidity, defined as ≥3 comorbid conditions. Multi-morbidity is associated with polypharmacy, adverse events, and frailty potentially altering response to anticoagulation. We sought to describe the prevalence of multi-morbidity among older patients with AF and determine the association between multi-morbidity, clinical outcomes, and the efficacy and safety of apixaban compared with warfarin. METHODS: In this post-hoc subgroup analysis of the ARISTOTLE trial, we studied enrolled patients age ≥ 55 years (n = 16,800). Patients were categorized by the number of comorbid conditions at baseline: no multi-morbidity (0-2 comorbid conditions), moderate multi-morbidity (3-5 comorbid conditions), and high multi-morbidity (≥6 comorbid conditions). Association between multi-morbidity and clinical outcomes were analyzed by treatment with a median follow-up of 1.8 (1.3-2.3) years. RESULTS: Multi-morbidity was present in 64% (n = 10,713) of patients; 51% (n = 8491) had moderate multi-morbidity, 13% (n = 2222) had high multi-morbidity, and 36% (n = 6087) had no multi-morbidity. Compared with the no multi-morbidity group, the high multi-morbidity group was older (74 vs 69 years), took twice as many medications (10 vs 5), and had higher CHA2DS2-VASc scores (4.9 vs 2.7) (all P < .001). Adjusted rates per 100 patient-years for stroke/systemic embolism, death, and major bleeding increased with multi-morbidity (Reference no multi-morbidity; moderate multi-morbidity 1.42 [1.24-1.64] and high multi-morbidity 1.92 [1.59-2.31]), with no interaction in relation to efficacy or safety of apixaban. CONCLUSIONS: Multi-morbidity is prevalent among the population with AF; efficacy and safety of apixaban is preserved in this subgroup supporting extension of trial results to the most complex AF patients.
BACKGROUND:Patients with atrial fibrillation (AF) often have multi-morbidity, defined as ≥3 comorbid conditions. Multi-morbidity is associated with polypharmacy, adverse events, and frailty potentially altering response to anticoagulation. We sought to describe the prevalence of multi-morbidity among older patients with AF and determine the association between multi-morbidity, clinical outcomes, and the efficacy and safety of apixaban compared with warfarin. METHODS: In this post-hoc subgroup analysis of the ARISTOTLE trial, we studied enrolled patients age ≥ 55 years (n = 16,800). Patients were categorized by the number of comorbid conditions at baseline: no multi-morbidity (0-2 comorbid conditions), moderate multi-morbidity (3-5 comorbid conditions), and high multi-morbidity (≥6 comorbid conditions). Association between multi-morbidity and clinical outcomes were analyzed by treatment with a median follow-up of 1.8 (1.3-2.3) years. RESULTS: Multi-morbidity was present in 64% (n = 10,713) of patients; 51% (n = 8491) had moderate multi-morbidity, 13% (n = 2222) had high multi-morbidity, and 36% (n = 6087) had no multi-morbidity. Compared with the no multi-morbidity group, the high multi-morbidity group was older (74 vs 69 years), took twice as many medications (10 vs 5), and had higher CHA2DS2-VASc scores (4.9 vs 2.7) (all P < .001). Adjusted rates per 100 patient-years for stroke/systemic embolism, death, and major bleeding increased with multi-morbidity (Reference no multi-morbidity; moderate multi-morbidity 1.42 [1.24-1.64] and high multi-morbidity 1.92 [1.59-2.31]), with no interaction in relation to efficacy or safety of apixaban. CONCLUSIONS: Multi-morbidity is prevalent among the population with AF; efficacy and safety of apixaban is preserved in this subgroup supporting extension of trial results to the most complex AFpatients.
Authors: Chris Wilkinson; Andrew Clegg; Oliver Todd; Kenneth Rockwood; Mohammad E Yadegarfar; Chris P Gale; Marlous Hall Journal: Age Ageing Date: 2020-12-16 Impact factor: 10.668
Authors: Chris Wilkinson; Andrew Clegg; Oliver Todd; Kenneth Rockwood; Mohammad E Yadegarfar; Chris P Gale; Marlous Hall Journal: Age Ageing Date: 2021-05-05 Impact factor: 10.668
Authors: Thibaut Galvain; Ruaraidh Hill; Sarah Donegan; Paulo Lisboa; Gregory Y H Lip; Gabriela Czanner Journal: Drug Saf Date: 2022-09-19 Impact factor: 5.228
Authors: Saket R Sanghai; Weisong Liu; Weijia Wang; Subendhu Rongali; Ariela R Orkaby; Jane S Saczynski; Adam J Rose; Alok Kapoor; Wenjun Li; Hong Yu; David D McManus Journal: J Gen Intern Med Date: 2021-05-04 Impact factor: 5.128
Authors: Marco Proietti; Giulio Francesco Romiti; Brian Olshansky; Deirdre A Lane; Gregory Y H Lip Journal: J Am Heart Assoc Date: 2020-05-06 Impact factor: 5.501
Authors: Frederik Dalgaard; Haolin Xu; Roland A Matsouaka; Andrea M Russo; Anne B Curtis; Peter Vibe Rasmussen; Martin H Ruwald; Gregg C Fonarow; Angela Lowenstern; Morten L Hansen; Jannik L Pallisgaard; Karen P Alexander; John H Alexander; Renato D Lopes; Christopher B Granger; William R Lewis; Jonathan P Piccini; Sana M Al-Khatib Journal: J Am Heart Assoc Date: 2020-11-26 Impact factor: 5.501