Four-year incidence of major adverse cardiovascular events in patients with atherosclerosis and atrial fibrillation.
Clin Cardiol
; 43(5): 524-531, 2020 May.
Article
em En
| MEDLINE
| ID: mdl-32106334
ABSTRACT
BACKGROUND:
There is a paucity of contemporary data assessing the implications of atrial fibrillation (AF) on major adverse cardiovascular events (MACE) in patients with or at high-risk for atherosclerotic disease managed in routine practice.HYPOTHESIS:
We sought to evaluate the 4-year incidence of MACE in patients with or at risk of atherosclerotic disease in the presence of AF.METHODS:
Using US MarketScan data, we identified AF patients ≥45 years old with billing codes indicating established coronary artery disease, cerebrovascular disease, or peripheral artery disease or the presence of ≥3 risk factors for atherosclerotic disease from January 1, 2013 to December 31, 2013 with a minimum of 4-years of available follow-up. We calculated the 4-year incidence of MACE (cardiovascular death or hospitalization with a primary billing code for myocardial infarction or ischemic stroke). Patients were further stratified by CHA2 DS2 -VASc score and oral anticoagulation (OAC) use at baseline.RESULTS:
We identified 625,951 patients with 4-years of follow-up, of which 77,752 (12.4%) had comorbid AF. The median (25%, 75% range) CHA2 DS2 -VASc score was 4 (3, 5) and 64% of patients received an OAC at baseline. The incidence of MACE increased as CHA2 DS2 -VASc scores increased (P-interaction<.0001 for all). AF patients receiving an OAC were less likely to experience MACE (8.9% vs 11.6%, P < .0001) including ischemic stroke (5.4% vs 6.7%, P < .0001).CONCLUSION:
Comorbid AF carries a substantial risk of MACE in patients with or at risk of atherosclerotic disease. MACE risk increases with higher CHA2 DS2 -VASc scores and is more likely in patients without OAC.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Índice de Gravidade de Doença
/
Indicadores Básicos de Saúde
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Aterosclerose
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article