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Multi-Morbidity, Anti-Thrombotic Treatment, and Mortality Among the Elderly Non-Valvular Atrial Fibrillation Patients: Results from the KERALA-AF Registry Study
43 Pages Posted: 9 Dec 2022
More...Abstract
Background: Reports on patients with Non valvular Atrial Fibrillation (NVAF) particularly in the elderly are few from India. This paper focuses on multimorbidity pattern, antithrombotic treatment and mortality of elderly NVAF patients from the state of Kerala. India.
Methods: Clinical details of NVAF patients of age ≥ 75 years from the cohort of KERALA-AF registry were analyzed for pattern of multimorbidity, antithrombotic treatment and one- year mortality.
Findings: The study comprised 753 patients with a median age of 80 years (IQR=77- 84) and 53.5% were male. Multimorbidity was present in 94.5% of patients. Hypertension was the commonest risk factor (74.4 %, n= 560) and chronic kidney disease was the major coexisting disease (78.9%, n= 594). Based on the number of comorbidities present, patients were grouped into three groups; <3 comorbidities (18.1%), 3- 5 comorbidities (63.9%), and >5 comorbidities (17.6%). Oral anticoagulant therapy (OAC) was received by 62.5% (n= 472) of patients, mostly Vitamin K antagonist (VKA). Direct oral anticoagulants (DOAC) were used in 11.3% of patients. Antiplatelet therapy was used in 60.6% and the most commonly used antiplatelet was clopidogrel (44.6%). No antithrombotic treatment was used in 12.0% of patients (n = 91). One-year all-cause mortality was 19.6% (n= 148), higher in women but not statistically significant (p=0.06). Kaplan- Meier survival curve indicated better one-year survival for patients who received OAC treatment (log rank test p <0.0001, HR= 0.49 (95% CI= 0.35, 0.68), concordance=0.58). Multivariate cox proportional hazards regression model showed OAC treatment (HR, 0.5; 95% CI, 0.36-0.7, P <0.001) and age more than 80 years (HR, 1.53; 95% CI, 1.11 -2.1, P <0.01) as predictors of one-year mortality. Mortality was not significantly different among the groups with different clustering of multimorbidity.
Interpretation: Elderly NVAF patients showed higher prevalence of multimorbidity, but pattern of multimorbidity did not influence mortality. Oral anticoagulant therapy reduced mortality by half even after adjusting for age, sex, comorbidities, and risk factors.
Trial Registration Details: CTRI/2017/10/010097.
Funding Information: The study received funding from the Cardiological Society of India- Kerala Chapter (CSI-K).
Declaration of Interests: None of the authors have any Competing Interests. GYH (co-author): Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871.
Ethics Approval Statement: The Ethics Committee of the Cardiological Society of India- Kerala Chapter, (Kerala Heart House, 2/280, Marad P.O, Kochi, 682 304, Kerala India) was the Central Ethics Committee that approved the study at all the participating sites. The following Ethics Committees also approved the study Ethics Committee, Ananthapuri Hospitals and Research Institute, Chaka, Thiruvananthapuram, 695024, Kerala, India Institutional Ethics Committee, Amritha Institute of Medical Sciences, Kochi, 682 041, Kerala, India Human Ethics Committee, Government Medical College, Thiruvananthapuram, 695024, Kerala, India Institutional Ethics Committee, Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam, 683594, Kerala, India Institutional Ethics Committee, Government Medical College, Kozhikode, Medical College PO, 673008, Kerala India Institutional Ethics Committee, Caritas Hospital, Thellakom, Pala, 686630, Kerala, India Institutional Ethics Committee, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, 695014, Kerala, India.
Keywords: Nonvalvular atrial fibrillation, multimorbidity, antithrombotic treatment, mortality, elderly NVAF patients, KERALA-AF Registry
Suggested Citation: Suggested Citation