Abstract
This observational study was conducted to describe the risk of gastrointestinal (GI) events among patients with atrial fibrillation (AF). We analyzed Thomson Reuters MarketScan® data from 2005 to 2009. Subjects aged ≥18 years with ≥ 1 AF diagnosis were selected. GI events were identified from claims with a primary or secondary diagnosis code for any GI condition. The risk of GI events was assessed using cumulative incidence (new GI events/patients with AF without GI condition at baseline) and incidence rates (IRs), calculated as the number of patients with new GI events divided by patient-years of observation. In addition, the CHADS2 score was evaluated at baseline to determine the patient’s risk of stroke. A total of 557,123 AF patients were identified. The mean (median) AF patient age was 68.2 years (70); 45% were female. The cumulative incidences of any GI event and dyspepsia were 40% and 19%, respectively. The corresponding IRs were 38.8 and 14.7 events per 100 patient–years. IRs of any GI events for female and male patients were 43.6 and 35.5; for patients in the age groups <65, 65–74, 75–84, and ≥85 years, IRs were 32.3, 38.9, 44.6, and 52.7; for patients with a CHADS2 score of 0, 1–2, 3–4, and 5–6, IRs were 30.3, 41.6, 56.9, and 74.5, respectively. In this large claims database, 40% of AF patients experienced a GI event, predominantly dyspepsia. Physicians should take age and comorbidities into consideration when managing AF patients.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-603) contains supplementary material, which is available to authorized users.
Highlights
Atrial fibrillation (AF) is the most common clinical arrhythmia; an estimated 2.3 million Americans were suffering from this condition in 2010 (Fuster et al 2001; Go et al 2001)
While literature documenting cardiovascular comorbidities is plentiful, less attention has been given to the prevalence and impact of gastrointestinal (GI) conditions such as dyspepsia, gastroesophageal reflux disease (GERD), peptic ulcer diseases, and GI bleeding in patients with AF (Hernandez-Diaz & Rodriguez 2002; Locke et al 1997; Talley et al 1992; Talley et al 1995)
Dyspepsia is regarded as a significant burden for AF patients (Lamori et al 2012), and in several studies of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, an important reason for discontinuing treatment (CAPRIE Steering Committee 1996; Cryer et al 2011; Niculescu et al 2009; Ofman et al 2003; Peto et al 1988; Saini et al 2009; Tournoij et al 2009)
Summary
Atrial fibrillation (AF) is the most common clinical arrhythmia; an estimated 2.3 million Americans were suffering from this condition in 2010 (Fuster et al 2001; Go et al 2001). For example, is a common condition in the elderly It is a likely comorbidity in patients with AF. In a recent retrospective observational study, subjects with AF presenting with dyspepsia tended to have a greater health burden and lower quality of life than those without dyspepsia These patients were at greater risk of stroke (Lamori et al 2012). The agents used in patients with AF to prevent stroke or treat other comorbidities are known to increase the risk of GI events. These agents include, but are not limited to, anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin), corticosteroids, and calcium channel blockers (Garcia Rodriguez et al 1998; Bytzer 2010). Agents currently used to treat patients with GI conditions or to counteract treatment-induced GI events typically include acid secretory inhibitors, such as proton pump inhibitors (PPIs) (Bytzer 2010; McGowan et al 2008; Yeomans et al 1998)
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