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Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation

BACKGROUND: Polypharmacy is highly prevalent in elderly people with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly patients with AF remains unaddressed. METHODS AND RESULTS: We studied 338 810 AF patien...

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Autores principales: Chen, Nemin, Alam, Aniqa B., Lutsey, Pamela L., MacLehose, Richard F., Claxton, J'Neka S., Chen, Lin Y., Chamberlain, Alanna M., Alonso, Alvaro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429010/
https://www.ncbi.nlm.nih.gov/pubmed/32448024
http://dx.doi.org/10.1161/JAHA.119.015089
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author Chen, Nemin
Alam, Aniqa B.
Lutsey, Pamela L.
MacLehose, Richard F.
Claxton, J'Neka S.
Chen, Lin Y.
Chamberlain, Alanna M.
Alonso, Alvaro
author_facet Chen, Nemin
Alam, Aniqa B.
Lutsey, Pamela L.
MacLehose, Richard F.
Claxton, J'Neka S.
Chen, Lin Y.
Chamberlain, Alanna M.
Alonso, Alvaro
author_sort Chen, Nemin
collection PubMed
description BACKGROUND: Polypharmacy is highly prevalent in elderly people with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly patients with AF remains unaddressed. METHODS AND RESULTS: We studied 338 810 AF patients ≥75 years of age enrolled in the MarketScan Medicare Supplemental database in 2007–2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis (defined by the presence of International Classification of Diseases, Ninth Revision, Clinical Modification [ICD‐9‐CM] codes) based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular end points (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient, and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular end points and the interaction between polypharmacy and AF treatments in relation to cardiovascular end points. Prevalence of polypharmacy was 52%. Patients with polypharmacy had increased risk of major bleeding (hazard ratio [HR], 1.16; 95% CI, 1.12–1.20) and heart failure (HR, 1.33; 95% CI, 1.29–1.36) but not ischemic stroke (HR, 0.96; 95% CI, 0.92–1.00), compared with those not receiving polypharmacy. Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. Rhythm control (versus rate control) was more effective in preventing heart failure hospitalization in patients not receiving polypharmacy (HR, 0.87; 95% CI, 0.76–0.99) than among those with polypharmacy (HR, 0.98; 95% CI, 0.91–1.07; P=0.02 for interaction). CONCLUSION: Polypharmacy is common among patients ≥75 with AF, is associated with adverse outcomes, and may modify the effectiveness of AF treatments. Optimizing management of polypharmacy in AF patients ≥75 may lead to improved outcomes.
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spelling pubmed-74290102020-08-18 Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation Chen, Nemin Alam, Aniqa B. Lutsey, Pamela L. MacLehose, Richard F. Claxton, J'Neka S. Chen, Lin Y. Chamberlain, Alanna M. Alonso, Alvaro J Am Heart Assoc Original Research BACKGROUND: Polypharmacy is highly prevalent in elderly people with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly patients with AF remains unaddressed. METHODS AND RESULTS: We studied 338 810 AF patients ≥75 years of age enrolled in the MarketScan Medicare Supplemental database in 2007–2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis (defined by the presence of International Classification of Diseases, Ninth Revision, Clinical Modification [ICD‐9‐CM] codes) based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular end points (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient, and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular end points and the interaction between polypharmacy and AF treatments in relation to cardiovascular end points. Prevalence of polypharmacy was 52%. Patients with polypharmacy had increased risk of major bleeding (hazard ratio [HR], 1.16; 95% CI, 1.12–1.20) and heart failure (HR, 1.33; 95% CI, 1.29–1.36) but not ischemic stroke (HR, 0.96; 95% CI, 0.92–1.00), compared with those not receiving polypharmacy. Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. Rhythm control (versus rate control) was more effective in preventing heart failure hospitalization in patients not receiving polypharmacy (HR, 0.87; 95% CI, 0.76–0.99) than among those with polypharmacy (HR, 0.98; 95% CI, 0.91–1.07; P=0.02 for interaction). CONCLUSION: Polypharmacy is common among patients ≥75 with AF, is associated with adverse outcomes, and may modify the effectiveness of AF treatments. Optimizing management of polypharmacy in AF patients ≥75 may lead to improved outcomes. John Wiley and Sons Inc. 2020-06-09 /pmc/articles/PMC7429010/ /pubmed/32448024 http://dx.doi.org/10.1161/JAHA.119.015089 Text en © 2020 The Authors and Mayo Clinic. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Chen, Nemin
Alam, Aniqa B.
Lutsey, Pamela L.
MacLehose, Richard F.
Claxton, J'Neka S.
Chen, Lin Y.
Chamberlain, Alanna M.
Alonso, Alvaro
Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title_full Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title_fullStr Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title_full_unstemmed Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title_short Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Patients ≥75 With Atrial Fibrillation
title_sort polypharmacy, adverse outcomes, and treatment effectiveness in patients ≥75 with atrial fibrillation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429010/
https://www.ncbi.nlm.nih.gov/pubmed/32448024
http://dx.doi.org/10.1161/JAHA.119.015089
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