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

Amgad Mentias; Alexandros Briasoulis; Ghanshyam Shantha; Paulino Alvarez; Mary Vaughan-Sarrazin

doi:10.1016/j.amjcard.2019.02.027

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

Journal article

Peer reviewed

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

Amgad Mentias, Alexandros Briasoulis, Ghanshyam Shantha, Paulino Alvarez and Mary Vaughan-Sarrazin

The American journal of cardiology, Vol.123(10), pp.1649-1653

05/15/2019

DOI: 10.1016/j.amjcard.2019.02.027

PMCID: PMC8263234

PMID: 30928033

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https://www.ncbi.nlm.nih.gov/pmc/articles/8263234View

Open Access

Abstract

Heart failure (HF) increases stroke risk in atrial fibrillation (AF) patients. Differential impact of HF category on thromboembolic and bleeding risk in AF patients on oral anticoagulation (OAC) is unknown. We used Medicare data for beneficiaries with new AF diagnosed between 2011 and 2013 to identify patients with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and no HF. The primary endpoint of admission for ischemic stroke was evaluated using Cox proportional hazards regression models that controlled for patient demographics, comorbidities (including CHA DS -VASc and HASBLED scores), and OAC use as a time-dependent covariate. Secondary endpoints included all-cause mortality, admissions for gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), acute myocardial infarction (AMI), or HF. The 3groups included 47840, 32360, and 718392 patients respectively. Patients with HFrEF and HFpEF had higher comorbidity burden, CHA DS -VASc and HASBLED scores compared with patients without HF. In multivariable analysis adjusting for patient comorbidities and OAC, HFrEF and HFpEF were associated with higher risk of ischemic stroke, HF and AMI compared with no HF. HFrEF was associated with higher all-cause mortality and HF-hospitalization risk compared with HFpEF. In conclusion, in AF patients, HFrEF and HFpEF are both associated with higher risk of ischemic stroke, HF and AMI admissions, even after adjusting for OAC use, compared with patients without HF.

Heart Failure - complications

United States - epidemiology

Survival Rate - trends

Anticoagulants - administration & dosage

Hemorrhage - epidemiology

Administration, Oral

Atrial Fibrillation - drug therapy

Humans

Atrial Fibrillation - complications

Heart Failure - physiopathology

Stroke Volume - physiology

Male

Thromboembolism - etiology

Thromboembolism - epidemiology

Incidence

Algorithms

Thromboembolism - prevention & control

Aged, 80 and over

Female

Registries

Aged

Retrospective Studies

Hemorrhage - chemically induced

Details

Title: Subtitle: Impact of Heart Failure Type on Thromboembolic and Bleeding Risk in Patients With Atrial Fibrillation on Oral Anticoagulation
Creators: Amgad Mentias - Department of Internal Medicine, Division of cardiovascular medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Alexandros Briasoulis - Department of Internal Medicine, Division of cardiovascular medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Ghanshyam Shantha - Division of cardiovascular medicine, University of Michigan, Ann Arbor, Michigan
Paulino Alvarez - Department of Internal Medicine, Division of cardiovascular medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Mary Vaughan-Sarrazin - Department of Internal Medicine, Division of cardiovascular medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, Iowa. Electronic address: mary-vaughan-sarrazin@uiowa.edu
Resource Type: Journal article
Publication Details: The American journal of cardiology, Vol.123(10), pp.1649-1653
DOI: 10.1016/j.amjcard.2019.02.027
PMID: 30928033
PMCID: PMC8263234
NLM abbreviation: Am J Cardiol
ISSN: 0002-9149
eISSN: 1879-1913
Publisher: United States
Grant note: R01 HS023104 / AHRQ HHS
Language: English
Date published: 05/15/2019
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984063119202771

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