Cardiovascular outcomes according to polypharmacy and drug adherence in patients with atrial fibrillation on long-term anticoagulation (from the RE-LY trial)
Prevalence of atrial fibrillation (AF) increases with age, along with comorbidities and, thus, polypharmacy. Non-adherence is associated with polypharmacy. This study aimed to identify patients at risk for cardiovascular events according to their pharmacological treatment intensity and adherence. Pa...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
15 June 2021
|
| In: |
The American journal of cardiology
Year: 2021, Volume: 149, Pages: 27-35 |
| ISSN: | 1879-1913 |
| DOI: | 10.1016/j.amjcard.2021.03.024 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.amjcard.2021.03.024 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0002914921002678 
|
| Author Notes: | Dominic Millenaar, Helmut Schumacher, Martina Brueckmann, John W. Eikelboom, Michael Ezekowitz, Jonathan Slawik, Sebastian Ewen, Christian Ukena, Lars Wallentin, Stuart Connolly, Salim Yusuf, and Michael Böhm |
| Summary: | Prevalence of atrial fibrillation (AF) increases with age, along with comorbidities and, thus, polypharmacy. Non-adherence is associated with polypharmacy. This study aimed to identify patients at risk for cardiovascular events according to their pharmacological treatment intensity and adherence. Patients (n=18,113) with a mean age of 71.5 ± 8.7 years, at high cardiovascular risk were followed between December 2005 until December 2007 for a median time of 2 years. The association between polypharmacy and adherence and their impact on cardiovascular and bleeding events were explored. Adherence was defined as a study drug intake of ≥80%. Patients with more co-medications had a higher body mass index, higher prevalence of hypertension, coronary heart disease, heart failure, and diabetes mellitus (all p < 0.0001) compared to ≤4 or 5-8 co-medications, but no differences in history of stroke (p=0.68) or transient ischemic attack (p=0.065). Across all treatments, the adjusted hazard ratios (HRs) increased in patients with more co-medications (≥9 vs ≤4) for all-cause death (HR 1.30; 1.06-1.59), major bleeding (HR 1.65; 1.33-2.05), and all bleeding events (HR 1.44; 1.31-1.59). Yearly event rates were higher in non-adherent than adherent patients for stroke and systemic embolism (SSE) (3.14 vs 1.00), all-cause death (7.76 vs 2.66), major bleeding (6.21 vs 2.65), and all bleeding (28.71 vs 19.05; all p < 0.0001). After an event the patients were more likely to become non-adherent (adherence after SSE 30.3%, after major bleeding 33.4%, after all bleeding 66.7%; all p < 0.0001). The treatment effects were consistent to the overall group in the different polypharmacy groups. In conclusion, polypharmacy and non-adherence are risk indicators for increased adverse cardiovascular and bleeding events. Dabigatran is safe to use across the full spectrum of AF patients, independent of the number of co-medications and adherence. Patients with co-medications and comorbidities require special attention and encouragement to adhere to oral anticoagulation. |
|---|---|
| Item Description: | Gesehen am 13.10.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1879-1913 |
| DOI: | 10.1016/j.amjcard.2021.03.024 |