Treatment of older patients with atrial fibrillation by morbidity burden
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Treatment of older patients with atrial fibrillation by morbidity burden. / Rasmussen, Peter Vibe; Pallisgaard, Jannik Langtved; Hansen, Morten Lock; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian; Ruwald, Martin; Alexander, Karen P.; Lopes, Renato D.; Al-Khatib, Sana M.; Dalgaard, Frederik.
In: European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 8, No. 1, 2022, p. 23-30.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Treatment of older patients with atrial fibrillation by morbidity burden
AU - Rasmussen, Peter Vibe
AU - Pallisgaard, Jannik Langtved
AU - Hansen, Morten Lock
AU - Gislason, Gunnar Hilmar
AU - Torp-Pedersen, Christian
AU - Ruwald, Martin
AU - Alexander, Karen P.
AU - Lopes, Renato D.
AU - Al-Khatib, Sana M.
AU - Dalgaard, Frederik
N1 - Publisher Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2022
Y1 - 2022
N2 - AIMS : Older patients with atrial fibrillation (AF) are at risk of adverse outcomes, which is accentuated by comorbidities. We sought to examine the association between morbidity burden and the treatment of older AF patients. METHODS AND RESULTS : Using Danish nationwide registers we included patients ≥70 years of age between 2010 and 2017 at their first hospitalization due to AF. Using multiple logistic regression models we examined the association between morbidity burden and the odds of receiving oral anticoagulants (OACs), anti-arrhythmic drugs (AADs), and rhythm-control procedures (direct current cardioversions and catheter ablations). A total of 48 995 patients were included with a majority of women (54%), with a median age of 80 years [interquartile range (IQR) 75-85], and a median morbidity burden of 2 comorbidities (IQR 1-3). Increasing morbidity burden was associated with decreasing odds of OAC treatment with patients having >5 comorbidities having the lowest odds [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.35-0.42] compared to patients with low morbidity burden (0-1 comorbidities). Having >5 comorbidities were associated with increased odds of AAD treatment (OR 1.90, 95% CI 1.64-2.21) and decreased odds of AF procedures (OR 0.39, 95% CI 0.31-0.48), compared to patients with a low morbidity burden (0-1 comorbidities). Examining morbidity burden continuously revealed similar results. CONCLUSIONS : In older AF patients, multimorbidity was associated with lower odds of receiving OACs and rhythm-control procedures but increased odds of AADs. This presents a clinical conundrum as multimorbid patients potentially benefit the most from treatment with OACs.
AB - AIMS : Older patients with atrial fibrillation (AF) are at risk of adverse outcomes, which is accentuated by comorbidities. We sought to examine the association between morbidity burden and the treatment of older AF patients. METHODS AND RESULTS : Using Danish nationwide registers we included patients ≥70 years of age between 2010 and 2017 at their first hospitalization due to AF. Using multiple logistic regression models we examined the association between morbidity burden and the odds of receiving oral anticoagulants (OACs), anti-arrhythmic drugs (AADs), and rhythm-control procedures (direct current cardioversions and catheter ablations). A total of 48 995 patients were included with a majority of women (54%), with a median age of 80 years [interquartile range (IQR) 75-85], and a median morbidity burden of 2 comorbidities (IQR 1-3). Increasing morbidity burden was associated with decreasing odds of OAC treatment with patients having >5 comorbidities having the lowest odds [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.35-0.42] compared to patients with low morbidity burden (0-1 comorbidities). Having >5 comorbidities were associated with increased odds of AAD treatment (OR 1.90, 95% CI 1.64-2.21) and decreased odds of AF procedures (OR 0.39, 95% CI 0.31-0.48), compared to patients with a low morbidity burden (0-1 comorbidities). Examining morbidity burden continuously revealed similar results. CONCLUSIONS : In older AF patients, multimorbidity was associated with lower odds of receiving OACs and rhythm-control procedures but increased odds of AADs. This presents a clinical conundrum as multimorbid patients potentially benefit the most from treatment with OACs.
KW - Ablation
KW - Aging
KW - Anti-arrhythmic drugs
KW - Atrial fibrillation
KW - Multimorbidity
KW - Oral anticoagulation
KW - Quality of care
U2 - 10.1093/ehjqcco/qcaa070
DO - 10.1093/ehjqcco/qcaa070
M3 - Journal article
C2 - 32857834
AN - SCOPUS:85104535677
VL - 8
SP - 23
EP - 30
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
SN - 2058-5225
IS - 1
ER -
ID: 291360070