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Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.

Publication ,  Journal Article
Washam, JB; Holmes, DN; Thomas, LE; Pokorney, SD; Hylek, EM; Fonarow, GC; Mahaffey, KW; Gersh, BJ; Kowey, PR; Ansell, JE; Go, AS; Reiffel, JA ...
Published in: J Am Heart Assoc
September 18, 2018

Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow-up data were included (N=9019). CKD was defined as an estimated creatinine clearance <60 mL /min. Patient characteristics were compared by CKD status, and Cox proportional hazards modeling was used to examine the association between oral anticoagulant ( OAC ) use and outcomes and antiarrhythmic drug use and outcomes stratified by CKD stages. At enrollment, 3490 (39%) patients had an estimated creatinine clearance <60 mL /min. Patients with CKD were older and had higher CHA 2 DS 2 VAS c and Anticoagulant and Risk Factors in Atrial Fibrillation (ATRIA) scores. A rhythm control strategy was selected less frequently in patients with CKD , while OAC use was lower among Stage IV and V CKD patients. After adjustment, no significant interaction was noted for OAC and CKD on all-cause mortality ( P=0.5442) or cardiovascular death ( P=0.1233), although a trend for increased major bleeding ( P=0.0608) and stroke, systemic embolism or transient ischemic attack ( P=0.0671) was observed. No interaction was noted for antiarrhythmic drug use and CKD status on all-cause mortality ( P=0.9706), or stroke, systemic embolism or transient ischemic attack ( P=0.4218). Conclusions Patients with atrial fibrillation and CKD are less likely to be treated with rhythm control. Patients with advanced CKD are less likely to receive OAC . Finally, outcomes with OAC in patients with advanced CKD may be materially different with higher rates of both bleeding and stroke.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

September 18, 2018

Volume

7

Issue

18

Start / End Page

e008928

Location

England

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Prospective Studies
  • Middle Aged
  • Male
 

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Washam, J. B., Holmes, D. N., Thomas, L. E., Pokorney, S. D., Hylek, E. M., Fonarow, G. C., … Piccini, J. P. (2018). Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF. J Am Heart Assoc, 7(18), e008928. https://doi.org/10.1161/JAHA.118.008928
Washam, Jeffrey B., DaJuanicia N. Holmes, Laine E. Thomas, Sean D. Pokorney, Elaine M. Hylek, Gregg C. Fonarow, Kenneth W. Mahaffey, et al. “Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.J Am Heart Assoc 7, no. 18 (September 18, 2018): e008928. https://doi.org/10.1161/JAHA.118.008928.
Washam JB, Holmes DN, Thomas LE, Pokorney SD, Hylek EM, Fonarow GC, et al. Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF. J Am Heart Assoc. 2018 Sep 18;7(18):e008928.
Washam, Jeffrey B., et al. “Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.J Am Heart Assoc, vol. 7, no. 18, Sept. 2018, p. e008928. Pubmed, doi:10.1161/JAHA.118.008928.
Washam JB, Holmes DN, Thomas LE, Pokorney SD, Hylek EM, Fonarow GC, Mahaffey KW, Gersh BJ, Kowey PR, Ansell JE, Go AS, Reiffel JA, Freeman JV, Singer DE, Naccarelli G, Blanco R, Peterson ED, Piccini JP. Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF. J Am Heart Assoc. 2018 Sep 18;7(18):e008928.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

September 18, 2018

Volume

7

Issue

18

Start / End Page

e008928

Location

England

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Prospective Studies
  • Middle Aged
  • Male