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Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial.

Publication ,  Journal Article
Alexander, KP; Brouwer, MA; Mulder, H; Vinereanu, D; Lopes, RD; Proietti, M; Al-Khatib, SM; Hijazi, Z; Halvorsen, S; Hylek, EM; Verheugt, FWA ...
Published in: Am Heart J
February 2019

BACKGROUND: Patients with atrial fibrillation (AF) often have multi-morbidity, defined as ≥3 comorbid conditions. Multi-morbidity is associated with polypharmacy, adverse events, and frailty potentially altering response to anticoagulation. We sought to describe the prevalence of multi-morbidity among older patients with AF and determine the association between multi-morbidity, clinical outcomes, and the efficacy and safety of apixaban compared with warfarin. METHODS: In this post-hoc subgroup analysis of the ARISTOTLE trial, we studied enrolled patients age ≥ 55 years (n = 16,800). Patients were categorized by the number of comorbid conditions at baseline: no multi-morbidity (0-2 comorbid conditions), moderate multi-morbidity (3-5 comorbid conditions), and high multi-morbidity (≥6 comorbid conditions). Association between multi-morbidity and clinical outcomes were analyzed by treatment with a median follow-up of 1.8 (1.3-2.3) years. RESULTS: Multi-morbidity was present in 64% (n = 10,713) of patients; 51% (n = 8491) had moderate multi-morbidity, 13% (n = 2222) had high multi-morbidity, and 36% (n = 6087) had no multi-morbidity. Compared with the no multi-morbidity group, the high multi-morbidity group was older (74 vs 69 years), took twice as many medications (10 vs 5), and had higher CHA2DS2-VASc scores (4.9 vs 2.7) (all P < .001). Adjusted rates per 100 patient-years for stroke/systemic embolism, death, and major bleeding increased with multi-morbidity (Reference no multi-morbidity; moderate multi-morbidity 1.42 [1.24-1.64] and high multi-morbidity 1.92 [1.59-2.31]), with no interaction in relation to efficacy or safety of apixaban. CONCLUSIONS: Multi-morbidity is prevalent among the population with AF; efficacy and safety of apixaban is preserved in this subgroup supporting extension of trial results to the most complex AF patients.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2019

Volume

208

Start / End Page

123 / 131

Location

United States

Related Subject Headings

  • Warfarin
  • Stroke
  • Pyridones
  • Pyrazoles
  • Polypharmacy
  • Multimorbidity
  • Middle Aged
  • Male
  • Humans
  • Hemorrhage
 

Citation

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Alexander, K. P., Brouwer, M. A., Mulder, H., Vinereanu, D., Lopes, R. D., Proietti, M., … ARISTOTLE Investigators. (2019). Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial. Am Heart J, 208, 123–131. https://doi.org/10.1016/j.ahj.2018.09.017
Alexander, Karen P., Marc A. Brouwer, Hillary Mulder, Dragos Vinereanu, Renato D. Lopes, Marco Proietti, Sana M. Al-Khatib, et al. “Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial.Am Heart J 208 (February 2019): 123–31. https://doi.org/10.1016/j.ahj.2018.09.017.
Alexander KP, Brouwer MA, Mulder H, Vinereanu D, Lopes RD, Proietti M, et al. Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial. Am Heart J. 2019 Feb;208:123–31.
Alexander, Karen P., et al. “Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial.Am Heart J, vol. 208, Feb. 2019, pp. 123–31. Pubmed, doi:10.1016/j.ahj.2018.09.017.
Alexander KP, Brouwer MA, Mulder H, Vinereanu D, Lopes RD, Proietti M, Al-Khatib SM, Hijazi Z, Halvorsen S, Hylek EM, Verheugt FWA, Alexander JH, Wallentin L, Granger CB, ARISTOTLE Investigators. Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial. Am Heart J. 2019 Feb;208:123–131.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2019

Volume

208

Start / End Page

123 / 131

Location

United States

Related Subject Headings

  • Warfarin
  • Stroke
  • Pyridones
  • Pyrazoles
  • Polypharmacy
  • Multimorbidity
  • Middle Aged
  • Male
  • Humans
  • Hemorrhage