Sex-Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation

Ghanshyam Palamaner Subash Shantha; Amgad Mentias; Chakradhari Inampudi; Anita A Kumar; Kongkiat Chaikriangkrai; Viraj Bhise; Abhishek Deshmukh; Nileshkumar Patel; Samir Pancholy; Phillip A Horwitz; Steven Mickelsen; Prashant D Bhave; Michael Giudici; Hakan Oral; Mary S Vaughan Sarrazin

doi:10.1161/JAHA.117.006381

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Sex-Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation

Journal article

Open access

Sex-Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation

Ghanshyam Palamaner Subash Shantha, Amgad Mentias, Chakradhari Inampudi, Anita A Kumar, Kongkiat Chaikriangkrai, Viraj Bhise, Abhishek Deshmukh, Nileshkumar Patel, Samir Pancholy, Phillip A Horwitz, …

Journal of the American Heart Association, Vol.6(8), e006381

08/18/2017

DOI: 10.1161/JAHA.117.006381

PMCID: PMC5586467

PMID: 28862952

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Abstract

Sex-specific effectiveness of rivaroxaban (RIVA), dabigatran (DABI), and warfarin in reducing myocardial infarction (MI), heart failure (HF), and all-cause mortality among patients with atrial fibrillation are not known. We assessed sex-specific associations of RIVA, DABI, or warfarin use with the risk of MI, HF, and all-cause mortality among patients with atrial fibrillation. Medicare beneficiaries (men: 65 734 [44.8%], women: 81 135 [55.2%]) with atrial fibrillation who initiated oral anticoagulants formed the study cohort. Inpatient admissions for MI, HF, and all-cause mortality were compared between the 3 drugs separately for men and women using 3-way propensity-matched samples. In men, RIVA use was associated with a reduced risk of MI admissions compared with warfarin use (hazard ratio [95% confidence interval (CI): 0.59 [0.38-0.91]), with a trend towards reduced risk compared with DABI use (0.67 [0.44-1.01]). In women, there were no significant differences in the risk of MI admissions across all 3 anticoagulants. In both sexes, RIVA use and DABI use were associated with reduced risk of HF admissions (men: RIVA; 0.75 [0.63-0.89], DABI; 0.81 [0.69-0.96]) (women: RIVA; 0.64 [0.56-0.74], DABI; 0.73 [0.63-0.83]) and all-cause mortality (men: RIVA; 0.66 [0.53-0.81], DABI; 0.75 [0.61-0.93]) (women: RIVA; 0.76 [0.63-0.91], DABI; 0.77 [0.64-0.93]) compared with warfarin use. RIVA use and DABI use when compared with warfarin use was associated with a reduced risk of HF admissions and all-cause mortality in both sexes. However, reduced risk of MI admissions noted with RIVA use appears to be limited to men.

Multivariate Analysis

United States - epidemiology

Dabigatran - adverse effects

Myocardial Infarction - mortality

Dabigatran - administration & dosage

Anticoagulants - administration & dosage

Humans

Patient Admission

Warfarin - adverse effects

Male

Warfarin - administration & dosage

Cause of Death

Rivaroxaban - administration & dosage

Heart Failure - prevention & control

Rivaroxaban - adverse effects

Time Factors

Atrial Fibrillation - mortality

Aged, 80 and over

Female

Heart Failure - diagnosis

Retrospective Studies

Atrial Fibrillation - diagnosis

Databases, Factual

Heart Failure - mortality

Myocardial Infarction - diagnosis

Medicare

Administration, Oral

Atrial Fibrillation - drug therapy

Risk Factors

Kaplan-Meier Estimate

Proportional Hazards Models

Treatment Outcome

Anticoagulants - adverse effects

Chi-Square Distribution

Propensity Score

Sex Factors

Administrative Claims, Healthcare

Aged

Myocardial Infarction - prevention & control

Details

Title: Subtitle: Sex-Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation
Creators: Ghanshyam Palamaner Subash Shantha - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Amgad Mentias - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Chakradhari Inampudi - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Anita A Kumar - Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Kongkiat Chaikriangkrai - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Viraj Bhise - Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, TX
Abhishek Deshmukh - Department of Electrophysiology, Mayo Clinic, Rochester, MN
Nileshkumar Patel - Department of Cardiology, Jackson Memorial Hospital, University of Miami, FL
Samir Pancholy - Department of Cardiovascular Medicine, The Wright Center for Graduate Medical Education, Scranton, PA
Phillip A Horwitz - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Steven Mickelsen - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Prashant D Bhave - Cardiology Division/Electrophysiology Section, Wake Forest Baptist Hospital, Winston-Salem, NC
Michael Giudici - Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Hakan Oral - Department of Electrophysiology, University of Michigan, Ann Arbor, MI
Mary S Vaughan Sarrazin - Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, Iowa City, IA
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.6(8), e006381
DOI: 10.1161/JAHA.117.006381
PMID: 28862952
PMCID: PMC5586467
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Publisher: England
Language: English
Date published: 08/18/2017
Academic Unit: Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984063125402771

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