TY - JOUR
T1 - Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation
AU - Loring, Zak
AU - Shrader, Peter
AU - Allen, Larry A.
AU - Blanco, Rosalia
AU - Chan, Paul S.
AU - Ezekowitz, Michael D.
AU - Fonarow, Gregg C.
AU - Freeman, James V.
AU - Gersh, Bernard J.
AU - Mahaffey, Kenneth W.
AU - Naccarelli, Gerald V.
AU - Pieper, Karen
AU - Reiffel, James A.
AU - Singer, Daniel E.
AU - Steinberg, Benjamin A.
AU - Thomas, Laine E.
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. Patients from the Outcomes for Better Informed Treatment of AF (ORBIT-AF and ORBIT-AF II) registries were considered for inclusion in this study. The details of these registries have been previously published. 12 , 13 Briefly, the ORBIT-AF and ORBIT-AF II registries enrolled ambulatory, adult patients with electrocardiographically documented AF from outpatient US practices and followed them semiannually tracking clinical outcomes and events for a minimum of 2 years. ORBIT-AF enrolled 10,137 patients from 176 sites from June 29, 2010, through August 9, 2011. ORBIT-AF II enrolled 13,394 patients from 244 US sites from February 20, 2013, through July 12, 2016. The study protocol was reviewed and approved by the Duke University Medical Center Institutional Review Board and the Institutional Review Board at each enrolling center. Primary funding was provided by Ortho-McNeil Janssen Scientific Affairs , LLC. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
Funding Information:
The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. Patients from the Outcomes for Better Informed Treatment of AF (ORBIT-AF and ORBIT-AF II) registries were considered for inclusion in this study. The details of these registries have been previously published.12,13 Briefly, the ORBIT-AF and ORBIT-AF II registries enrolled ambulatory, adult patients with electrocardiographically documented AF from outpatient US practices and followed them semiannually tracking clinical outcomes and events for a minimum of 2 years. ORBIT-AF enrolled 10,137 patients from 176 sites from June 29, 2010, through August 9, 2011. ORBIT-AF II enrolled 13,394 patients from 244 US sites from February 20, 2013, through July 12, 2016. The study protocol was reviewed and approved by the Duke University Medical Center Institutional Review Board and the Institutional Review Board at each enrolling center. Primary funding was provided by Ortho-McNeil Janssen Scientific Affairs, LLC. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.Z. L. is supported in part by an NIH T32 training grant (#5T32HL069749). P. S. has no relationships to disclose. L. A. A. received consulting fees from Janssen, ACI Clinical, Amgen, and Boston Scientific and grant funding from AHA, PCORI, and NIH. R. B. has no relationships to disclose. P. S. C. discloses consulting for Optum Rx. M. D. E. discloses consulting/advisory board for Boehringer Ingelheim, Diachi Sanko, Pfizer, Bristol Myers Squibb, and Janssen Scientific Affairs. G. C. F. discloses consulting for Abbott, Amgen, Bayer, Janssen, Medtronic, and Novartis. J. V. F. serves as a consultant on the advisory board for Janssen Scientific, Medtronic, Biosense Webster, and Boston Scientific and receives salary support from the American College of Cardiology. B. J. G. discloses membership of a data safety monitoring board for Mount Sinai St Lukes, Boston Scientific Corporation, Teva Pharmaceutical Industries, St Jude Medical, Janssen Research & Development, Baxter Healthcare Corporation, and Cardiovascular Research Foundation as well as consulting/advisory board for Janssen Scientific Affairs, Cipla Limited, Armetheon Inc, and Medtronic. K. W. F.'s financial disclosures can be viewed at http://med.stanford.edu/profiles/kenneth-mahaffey. G. V. N. discloses research support from Janssen and consults for Janssen, Omeicos, Acesion, and Milestone. K. P. has no relationships to disclose. J. A. R. has been an investigator and consultant for Medtronic, Janssen, Gilead, and Sanofi; a consultant for Portola, Acesion, and InCardia Therapeutics; and a member of speaker's bureaus for Janssen and Boehringer Ingelheim. D. E. S. discloses consulting/advisory board for Boehringer Ingelheim, Johnson and Johnson, Merck, Pfizer, and Bristol-Myers Squibb and conducts contracted research with Bristol-Myers Squibb and Boehringer Ingelheim. B. A. S. is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL143156; receives research support from Boston Scientific and Janssen; consulting to Janssen and Merit Medical; speaking for NACCME (funded by Sanofi). L. E. T. receives grants from Jansen and BMS. E. D. P. receives grants from Janssen Pharmaceuticals and Eli Lilly and discloses consulting for Janssen Pharmaceuticals and Boehringer Ingelheim. J. P. P. receives grants for clinical research from Abbott, American Heart Association, Boston Scientific, Gilead, Janssen Pharmaceuticals, and the NHLBI and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, Johnson & Johnson, LivaNova, Medtronic, Milestone, Oliver Wyman Health, Sanofi, Philips, and Up-to-Date.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/1
Y1 - 2020/1
N2 - 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.
AB - 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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U2 - 10.1016/j.ahj.2019.10.008
DO - 10.1016/j.ahj.2019.10.008
M3 - Article
C2 - 31710841
AN - SCOPUS:85074657829
SN - 0002-8703
VL - 219
SP - 21
EP - 30
JO - American Heart Journal
JF - American Heart Journal
ER -