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Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation.

Publication ,  Journal Article
Loring, Z; Shrader, P; Allen, LA; Blanco, R; Chan, PS; Ezekowitz, MD; Fonarow, GC; Freeman, JV; Gersh, BJ; Mahaffey, KW; Naccarelli, GV ...
Published in: Am Heart J
January 2020

BACKGROUND: Comorbidities are common in patients with atrial fibrillation (AF) and affect prognosis, yet are often undertreated. However, contemporary rates of use of guideline-directed therapies (GDT) for non-AF comorbidities and their association with outcomes are not well described. METHODS: We used the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) to test the association between GDT for non-AF comorbidities and major adverse cardiac or neurovascular events (MACNE; cardiovascular death, myocardial infarction, stroke/thromboembolism, or new-onset heart failure), all-cause mortality, new-onset heart failure, and AF progression. Adjustment was performed using Cox proportional hazards models and logistic regression. RESULTS: Only 6,782 (33%) of the 20,434 patients eligible for 1 or more GDT for non-AF comorbidities received all indicated therapies. Use of all comorbidity-specific GDT was highest for patients with hyperlipidemia (75.6%) and lowest for those with diabetes mellitus (43.1%). Use of "all eligible" GDT was associated with a nonsignificant trend toward lower rates of MACNE (HR 0.90 [0.79-1.02]) and all-cause mortality (HR 0.90 [0.80-1.01]). Use of GDT for heart failure was associated with a lower risk of all-cause mortality (HR 0.77 [0.67-0.89]), and treatment of obstructive sleep apnea was associated with a lower risk of AF progression (OR 0.75 [0.62-0.90]). CONCLUSIONS: In AF patients, there is underuse of GDT for non-AF comorbidities. The association between GDT use and outcomes was strongest in heart failure and obstructive sleep apnea patients where use of GDT was associated with lower mortality and less AF progression.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2020

Volume

219

Start / End Page

21 / 30

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sleep Apnea, Obstructive
  • Registries
  • Peripheral Vascular Diseases
  • Peripheral Nervous System Diseases
  • Male
  • Intracranial Embolism
  • Hypertension
  • Hyperlipidemias
  • Humans
 

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Loring, Z., Shrader, P., Allen, L. A., Blanco, R., Chan, P. S., Ezekowitz, M. D., … Piccini, J. P. (2020). Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. Am Heart J, 219, 21–30. https://doi.org/10.1016/j.ahj.2019.10.008
Loring, Zak, Peter Shrader, Larry A. Allen, Rosalia Blanco, Paul S. Chan, Michael D. Ezekowitz, Gregg C. Fonarow, et al. “Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation.Am Heart J 219 (January 2020): 21–30. https://doi.org/10.1016/j.ahj.2019.10.008.
Loring Z, Shrader P, Allen LA, Blanco R, Chan PS, Ezekowitz MD, et al. Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. Am Heart J. 2020 Jan;219:21–30.
Loring, Zak, et al. “Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation.Am Heart J, vol. 219, Jan. 2020, pp. 21–30. Pubmed, doi:10.1016/j.ahj.2019.10.008.
Loring Z, Shrader P, Allen LA, Blanco R, Chan PS, Ezekowitz MD, Fonarow GC, Freeman JV, Gersh BJ, Mahaffey KW, Naccarelli GV, Pieper K, Reiffel JA, Singer DE, Steinberg BA, Thomas LE, Peterson ED, Piccini JP. Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. Am Heart J. 2020 Jan;219:21–30.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2020

Volume

219

Start / End Page

21 / 30

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sleep Apnea, Obstructive
  • Registries
  • Peripheral Vascular Diseases
  • Peripheral Nervous System Diseases
  • Male
  • Intracranial Embolism
  • Hypertension
  • Hyperlipidemias
  • Humans