Effect of Heart Failure Type on Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients on Oral Anticoagulation

Amgad Mentias; Ghanshyam Palamaner; Alexandros Briasoulis; Paulino Alvarez; Mary Vaughan-sarrazin

doi:10.1016/j.cardfail.2018.07.274

Back

Effect of Heart Failure Type on Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients on Oral Anticoagulation

Abstract

Open access

Peer reviewed

Effect of Heart Failure Type on Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients on Oral Anticoagulation

Amgad Mentias, Ghanshyam Palamaner, Alexandros Briasoulis, Paulino Alvarez and Mary Vaughan-sarrazin

Journal of cardiac failure, Vol.24(8), pp.S62-S63

08/2018

DOI: 10.1016/j.cardfail.2018.07.274

Files and links (1)

url

https://doi.org/10.1016/j.cardfail.2018.07.274View

Published (Version of record) Open Access

Abstract

Heart failure (HF) increases ischemic stroke (IS) risk in atrial fibrillation (AF) patients. Differential effect of heart failure type on thromboembolic and bleeding risk while on oral anticoagulation (OAC) is unknown. We used Medicare data for beneficiaries with new AF diagnosed during 2011-13 to identify patients with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and no HF. The primary outcome of admission for IS was evaluated using Cox proportional hazards regression models that controlled for patient demographics, comorbidities (including CHA2DS2-Vasc score), and OAC use. Secondary outcomes included mortality, admissions for gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), acute myocardial infarction (AMI), or HF. The 3 groups included 47840, 32360 and 718392 patients respectively. Patients with HFrEF and HFpEF had higher comorbidity burden, thromboembolic and bleeding risk (Table 1). In multivariable analysis adjusting for patient characteristics and OAC as a time-dependent covariate, HFrEF and HFpEF were associated with higher risk of IS, HF and AMI compared to no HF (Table 2). HFrEF was associated with higher all-cause mortality and HF-hospitalization risk compared with HFpEF (Table 2) In AF patients, HFrEF and HFpEF are both associated with higher risk of stroke, HF and AMI admissions, even after adjusting for OAC, compared with patients without HF.

Details

Title: Subtitle: Effect of Heart Failure Type on Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients on Oral Anticoagulation
Creators: Amgad Mentias - University of Iowa
Ghanshyam Palamaner - University of Iowa
Alexandros Briasoulis - University of Iowa
Paulino Alvarez - University of Iowa
Mary Vaughan-sarrazin - University of Iowa
Resource Type: Abstract
Publication Details: Journal of cardiac failure, Vol.24(8), pp.S62-S63
Publisher: Elsevier Inc
DOI: 10.1016/j.cardfail.2018.07.274
ISSN: 1071-9164
eISSN: 1532-8414
Language: English
Date published: 08/2018
Academic Unit: General Internal Medicine; Internal Medicine; Health Management and Policy
Record Identifier: 9984363446502771

Metrics

5 Record Views