Original articleLong-Term Relationship Between Atrial Fibrillation, Multimorbidity and Oral Anticoagulant Drug Use
Section snippets
Data Source and Study Population
This study used linkable administrative health databases from the Lombardy Region that include the demographic data of all residents and detailed information on hospital admissions and drug prescriptions. To date, with a population of more than 10 million inhabitants, Lombardy is the largest Italian region, comprising highly populated urban areas and industrial and rural ones. The Italian health care system is based on a public National Health Service, which provides free assistance to anyone
Results
In 2002, a cohort of patients with 24,040 and 240,400 subjects without AF was created. At baseline (Table 1), patients with AF had a significantly higher mean (±SD) CCI than did those without AF (1.8±2.1 vs 0.2±0.9; P<.001). Patients with AF were significantly older and more likely to be male, and they were more likely to be affected by comorbidities compared with subjects with AF. Accordingly, patients with AF had a significantly higher mean (±SD) CHA₂DS₂-VASc score (3.3±1.4 vs 1.4±1.2; P
Discussion
Our study showed that patients with AF are exposed to a higher burden of overall multimorbidity than are individuals without AF, showing a direct relationship between AF and increasing multimorbidity burden over long-term follow-up, regardless of age. Second, an increased burden of multimorbidity is inversely associated with OAC prescription, which could significantly affect the clinical history of patients with AF, despite not influencing treatment discontinuation. Third, an increased burden
Conclusion
In hospitalized patients, AF is associated with an independent increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI was independently associated with an increased risk of stroke, major bleeding, and all-cause death. New models of care that consider the burden of comorbidities in patients and offer holistic approaches to AF management are needed.
Acknowledgments
The authors thank Igor Monti from Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Simone Schiatti and Giovanna Rigotti from Lombardia Informatica S.p.A, and Alfredo Bevilacqua from SANTER Reply S.p.A.
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For editorial comment, see page 2381
Dr Proietti and Dr Marzona contributed equally to this work.
Potential Competing Interests: Dr Proietti reports consultant activity for Boehringer Ingelheim. Dr Mannucci reports honoraria for lectures as speaker or chair symposia organized by Bayer, Grifols, Kedrion, LFB, Novo Nordisk, and Pfizer; he is also a scientific consultant for Bayer, Baxalta, and Kedrion. Dr Boriani reports speaker’s fees from Medtronic, Boston, Boehringer, and Bayer. Dr Lip reports consultant activity for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, and Daiichi-Sankyo and speaker activity for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo. No fees are received personally. All relationships disclosed are related to activities performed outside the submitted work. All other authors have no disclosures to declare.