Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation.
Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation.
复制标题
针对心房颤动患者的合并症和临床结果的指南指导治疗。
DOI：
10.1016/j.ahj.2019.10.008
复制
发表时间：
2020
影响因子：
4.8
通讯作者：
Steinberg
中科院分区：
文献类型：
--
作者：
Loring,Zak;Shrader,Peter;Allen,LarryA;Blanco,Rosalia;Chan,PaulS;Ezekowitz,MichaelD;Fonarow,GreggC;Freeman,JamesV;Gersh,BernardJ;Mahaffey,KennethW;Naccarelli,GeraldV;Pieper,Karen;Reiffel,JamesA;Singer,DanielE;Steinberg
BackgroundComorbidities 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.MethodsWe 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.ResultsOnly 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]).ConclusionsIn 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.
