Monika Kozieł1,2, Stefan Simovic3, Nikola Pavlovic4, Aleksandar Kocijancic5, Vilma Paparisto6, Ljilja Music7, Elina Trendafilova8, Anca Rodica Dan9, Zumreta Kusljugic10, Gheorghe-Andrei Dan11, Gregory Y H Lip1,2,12,13, Tatjana S Potpara5,12. 1. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. 2. First Department of Cardiology and Angiology, Silesian Centre for Heart Diseases, Zabrze, Poland. 3. Cardiology Clinic, University Clinical Center of Kragujevac, Kragujevac, Serbia. 4. Clinical Center Sestre Milosrdnice, Zagreb, Croatia. 5. Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia. 6. Clinic of Cardiology, University Hospital Center Mother Theresa, Tirana, Albania. 7. Cardiology Clinic, Medical Faculty, University Clinical Center of Montenegro, University of Podgorica, Podgorica, Montenegro. 8. Coronary Care Unit, National Heart Hospital, Sofia, Bulgaria. 9. Cardiology Department, Colentina University Hospital, Bucharest, Romania. 10. Cardiology Department, Clinic of Internal Medicine, Medical Faculty, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina. 11. Medicine University "Carol Davila", Colentina University Hospital, Bucharest, Romania. 12. School of Medicine, Belgrade University, Belgrade, Serbia. 13. Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark.
Abstract
OBJECTIVE: We investigated the impact of multimorbidity and polypharmacy on the management of atrial fibrillation (AF) patients in clinical practice and assessed factors associated with polypharmacy and oral anticoagulation (OAC) use in AF patients with multimorbidity and polypharmacy. METHODS: A 14-week prospective study of consecutive non-valvular AF patients was performed in seven Balkan countries. RESULTS: Of 2712 consecutive patients, 2263 patients (83.4%) had multimorbidity (AF + ≥2 concomitant diseases) and 1505 patients (55.5%) had polypharmacy. 1416 (52.2%) patients had both multimorbidity and polypharmacy. Overall, 1164 (82.2%) patients received OAC, 200 (14.1%) patients received antiplatelet drugs alone and 52 (3.7%) patients had no antithrombotic therapy (AT). Non-emergency centre and paroxysmal AF were significantly associated with OAC non-use in patients with multimorbidity, whilst age ≥80 years and non-emergency centre were identified to be independent predictors of OAC non-use in patients with polypharmacy. CONCLUSIONS: Multimorbidity and polypharmacy were common among AF patients in our study. AT was suboptimal and approximately 18% of multimorbid patients with polypharmacy were not anticoagulated. Pattern of AF and non-emergency centre were associated with OAC non-use in AF patients with multimorbidity, whilst non-emergency centre and age ≥80 years were associated with OAC non-use in AF patients with polypharmacy. Key Message Multimorbidity and polypharmacy are common among patients with AF. Antithrombotic therapy was suboptimal in AF patients with multimorbidity and polypharmacy. Approximately, 18% of multimorbid patients with polypharmacy were not anticoagulated.
OBJECTIVE: We investigated the impact of multimorbidity and polypharmacy on the management of atrial fibrillation (AF) patients in clinical practice and assessed factors associated with polypharmacy and oral anticoagulation (OAC) use in AFpatients with multimorbidity and polypharmacy. METHODS: A 14-week prospective study of consecutive non-valvular AFpatients was performed in seven Balkan countries. RESULTS: Of 2712 consecutive patients, 2263 patients (83.4%) had multimorbidity (AF + ≥2 concomitant diseases) and 1505 patients (55.5%) had polypharmacy. 1416 (52.2%) patients had both multimorbidity and polypharmacy. Overall, 1164 (82.2%) patients received OAC, 200 (14.1%) patients received antiplatelet drugs alone and 52 (3.7%) patients had no antithrombotic therapy (AT). Non-emergency centre and paroxysmal AF were significantly associated with OAC non-use in patients with multimorbidity, whilst age ≥80 years and non-emergency centre were identified to be independent predictors of OAC non-use in patients with polypharmacy. CONCLUSIONS: Multimorbidity and polypharmacy were common among AFpatients in our study. AT was suboptimal and approximately 18% of multimorbid patients with polypharmacy were not anticoagulated. Pattern of AF and non-emergency centre were associated with OAC non-use in AFpatients with multimorbidity, whilst non-emergency centre and age ≥80 years were associated with OAC non-use in AFpatients with polypharmacy. Key Message Multimorbidity and polypharmacy are common among patients with AF. Antithrombotic therapy was suboptimal in AFpatients with multimorbidity and polypharmacy. Approximately, 18% of multimorbid patients with polypharmacy were not anticoagulated.
Authors: Giulio Francesco Romiti; Marco Proietti; Giuseppe Boriani; Gregory Y H Lip; Marco Vitolo; Niccolò Bonini; Ameenathul Mazaya Fawzy; Wern Yew Ding; Laurent Fauchier; Francisco Marin; Michael Nabauer; Gheorghe Andrei Dan; Tatjana S Potpara Journal: BMC Med Date: 2022-09-02 Impact factor: 11.150