Kotalczyk Agnieszka, Guo Yutao, Wang Yutang, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK.
Silesian Centre for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, 41-800 Zabrze, Poland.
J Clin Med. 2022 Mar 2;11(5):1370. doi: 10.3390/jcm11051370.
The co-incidence of multiple morbidities and polypharmacy is common amongst patients with atrial fibrillation (AF); however, data on their impact on clinical outcomes are scarce in Asian cohorts.
To evaluate the impact of multimorbidity and polypharmacy on clinical outcomes and AF management among elderly Chinese patients.
The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, cardiovascular death, TE events, major bleeding, as well as AF management.
The eligible cohort included 6341 individuals (mean age 74.7 ± 10.7; 39.1% female), of whom 4644 (73.2%) had multimorbidity (defined as two or more chronic diseases), and 2262 (35.7%) were treated with five or more medications. There were 2775 (43.8%) patients on anticoagulant (OAC) use. On multivariate analysis, (i) multimorbidity was associated with a higher odds ratio of the composite outcome (OR: 2.04; 95% CI: 1.49-2.79), all-cause death (OR: 1.82; 95% CI: 1.31-2.54), cardiovascular death (OR: 2.05; 95% CI: 1.13-3.69), any TE (OR: 2.69; 95% CI: 1.29-5.62), and major bleeding (OR: 2.61; 95% CI: 1.25-5.45); (ii) polypharmacy was associated with a lower odds ratio of all-cause death (OR: 0.78; 95% CI: 0.63-0.96). The use of OAC was safe and was associated with a lower odds ratio of the composite outcome and all-cause death in all subgroups of patients.
Multimorbidity and polypharmacy were common among elderly AF Chinese patients. Multimorbidity was an independent predictor of adverse clinical outcomes. The use of OAC was safe and significantly improved survival amongst AF patients with multimorbidity and polypharmacy.
多种疾病并存和多重用药在心房颤动（AF）患者中很常见；然而，在亚洲队列中，关于它们对临床结局影响的数据很少。
评估多种疾病并存和多重用药对中国老年患者临床结局及房颤管理的影响。
ChiOTEAF注册研究是一项于2014年10月至2018年12月进行的前瞻性、多中心全国性研究。感兴趣的终点是全因死亡/任何血栓栓塞（TE）、全因死亡、心血管死亡、TE事件、大出血以及房颤管理的复合结局。
符合条件的队列包括6341人（平均年龄74.7±10.7岁；女性占39.1%），其中4644人（73.2%）患有多种疾病（定义为两种或更多种慢性病），2262人（35.7%）使用五种或更多种药物治疗。有2775名（43.8%）患者使用抗凝剂（OAC）。多因素分析显示，（i）多种疾病并存与复合结局（比值比：2.04；95%置信区间：1.49 - 2.79）、全因死亡（比值比：1.82；95%置信区间：1.31 - 2.54）、心血管死亡（比值比：2.05；95%置信区间：1.13 - 3.69）以及任何TE（比值比：2.69；95%置信区间：1.29 - 5.62）和大出血（比值比：2.61；95%置信区间：1.25 - 5.45）的较高比值比相关；（ii）多重用药与全因死亡的较低比值比相关（比值比：0.78；95%置信区间：0.63 - 0.96）。在所有患者亚组中，使用OAC是安全的，并且与复合结局和全因死亡的较低比值比相关。
多种疾病并存和多重用药在中国老年房颤患者中很常见。多种疾病并存是不良临床结局的独立预测因素。使用OAC是安全的，并且显著改善了患有多种疾病并存和多重用药的房颤患者的生存率。
