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

Zak Loring, Peter Shrader, Larry A. Allen, Rosalia Blanco, Paul S. Chan, Michael D. Ezekowitz, Gregg C. Fonarow, James V. Freeman, Bernard J. Gersh, Kenneth W. Mahaffey, Gerald V. Naccarelli, Karen Pieper, James A. Reiffel, Daniel E. Singer, Benjamin A. Steinberg, Laine E. Thomas, Eric D. Peterson, Jonathan P. Piccini

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)21-30
Number of pages10
JournalAmerican Heart Journal
Volume219
DOIs
StatePublished - Jan 2020

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Atrial Fibrillation
Comorbidity
Guidelines
Therapeutics
Heart Failure
Mortality
Obstructive Sleep Apnea
Thromboembolism
Hyperlipidemias
Proportional Hazards Models
Registries
Diabetes Mellitus
Logistic Models
Stroke
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. American Heart Journal, 219, 21-30. https://doi.org/10.1016/j.ahj.2019.10.008
Loring, Zak ; Shrader, Peter ; Allen, Larry A. ; Blanco, Rosalia ; Chan, Paul S. ; Ezekowitz, Michael D. ; Fonarow, Gregg C. ; Freeman, James V. ; Gersh, Bernard J. ; Mahaffey, Kenneth W. ; Naccarelli, Gerald V. ; Pieper, Karen ; Reiffel, James A. ; Singer, Daniel E. ; Steinberg, Benjamin A. ; Thomas, Laine E. ; Peterson, Eric D. ; Piccini, Jonathan P. / Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. In: American Heart Journal. 2020 ; Vol. 219. pp. 21-30.
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abstract = "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.",
author = "Zak Loring and Peter Shrader and Allen, {Larry A.} and Rosalia Blanco and Chan, {Paul S.} and Ezekowitz, {Michael D.} and Fonarow, {Gregg C.} and Freeman, {James V.} and Gersh, {Bernard J.} and Mahaffey, {Kenneth W.} and Naccarelli, {Gerald V.} and Karen Pieper and Reiffel, {James A.} and Singer, {Daniel E.} and Steinberg, {Benjamin A.} and Thomas, {Laine E.} and Peterson, {Eric D.} and Piccini, {Jonathan P.}",
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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 2020, 'Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation', American Heart Journal, vol. 219, pp. 21-30. https://doi.org/10.1016/j.ahj.2019.10.008

Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. / Loring, Zak; Shrader, Peter; Allen, Larry A.; Blanco, Rosalia; Chan, Paul S.; Ezekowitz, Michael D.; Fonarow, Gregg C.; Freeman, James V.; Gersh, Bernard J.; Mahaffey, Kenneth W.; Naccarelli, Gerald V.; Pieper, Karen; Reiffel, James A.; Singer, Daniel E.; Steinberg, Benjamin A.; Thomas, Laine E.; Peterson, Eric D.; Piccini, Jonathan P.

In: American Heart Journal, Vol. 219, 01.2020, p. 21-30.

Research output: Contribution to journalArticle

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.

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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