Abstract
Background: The co-incidence of multiple morbidities and polypharmacy is common amongst patients with atrial fibrillation (AF); however, data on their impact on clinical outcomes are scarce in Asian cohorts. Objective: To evaluate the impact of multimorbidity and polypharmacy on clinical outcomes and AF management among elderly Chinese patients. Methods: The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, cardiovascular death, TE events, major bleeding, as well as AF management. Results: The eligible cohort included 6341 individuals (mean age 74.7 ± 10.7; 39.1% female), of whom 4644 (73.2%) had multimorbidity (defined as two or more chronic diseases), and 2262 (35.7%) were treated with five or more medications. There were 2775 (43.8%) patients on anticoagulant (OAC) use. On multivariate analysis, (i) multimorbidity was associated with a higher odds ratio of the composite outcome (OR: 2.04; 95% CI: 1.49–2.79), all-cause death (OR: 1.82; 95% CI: 1.31–2.54), cardiovascular death (OR: 2.05; 95% CI: 1.13–3.69), any TE (OR: 2.69; 95% CI: 1.29–5.62), and major bleeding (OR: 2.61; 95% CI: 1.25–5.45); (ii) polypharmacy was associated with a lower odds ratio of all-cause death (OR: 0.78; 95% CI: 0.63–0.96). The use of OAC was safe and was associated with a lower odds ratio of the composite outcome and all-cause death in all subgroups of patients. Conclusions: Multimorbidity and polypharmacy were common among elderly AF Chinese patients. Multimorbidity was an independent predictor of adverse clinical outcomes. The use of OAC was safe and significantly improved survival amongst AF patients with multimorbidity and polypharmacy.
Highlights
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its increasing prevalence is driven by population aging and being overburdened with comorbidities [1–3]
The primary findings of the present study are as follows: (i) 73.2% of elderly atrial fibrillation (AF) patients had multimorbidity, while polypharmacy was present in 35.7% of patients; (ii) multimorbidity was associated with higher rates of the composite outcome, all-cause death, cardiovascular death, any TE, and major bleeding; and was an independent predictor of the adverse clinical outcomes; (iii) the independent predictors of the composite outcome among multimorbidity patients were the non-use of OAC, age, heart failure, prior ischemic stroke, chronic kidney disease, chronic obstructive pulmonary disease, and non-polypharmacy; (iv) multimorbidity was associated with a higher odds ratio of antiplatelet use and rate control strategy; and (v) OAC use was safe and improved survival in AF patients with multimorbidity, as well as polypharmacy
The present study shows how OAC has reduced the composite outcome of all-cause death and any thromboembolism in this complex AF population with multimorbidity, re-emphasizing the importance of optimal thromboprophylaxis
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its increasing prevalence is driven by population aging and being overburdened with comorbidities [1–3]. Data on multimorbidity and polypharmacy among Asian patients with AF are scarce, especially among elderly individuals. This analysis evaluates the prognosis and impact of multimorbidity and polypharmacy on clinical outcomes and AF management among elderly Chinese patients included in a prospective nationwide registry. The co-incidence of multiple morbidities and polypharmacy is common amongst patients with atrial fibrillation (AF); data on their impact on clinical outcomes are scarce in Asian cohorts. On multivariate analysis, (i) multimorbidity was associated with a higher odds ratio of the composite outcome (OR: 2.04; 95% CI: 1.49–2.79), all-cause death (OR: 1.82; 95% CI: 1.31–2.54), cardiovascular death (OR: 2.05; 95% CI: 1.13–3.69), any TE (OR: 2.69; 95% CI: 1.29–5.62), and major bleeding (OR: 2.61; 95% CI: 1.25–5.45); (ii) polypharmacy was associated with a lower odds ratio of all-cause death (OR: 0.78; 95% CI: 0.63–0.96). The use of OAC was safe and significantly improved survival amongst AF patients with multimorbidity and polypharmacy
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