P1900Amiodarone treatment duration and reasons for permanent drug discontinuation in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Mihajlovic ◽  
A Mihajlovic ◽  
M Marinkovic ◽  
V Kovacevic ◽  
L Vajagic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Side Effects ◽  
Cox Regression ◽  
Daily Practice ◽  
Arterial Disease ◽  
Drug Discontinuation ◽  
Cox Regression Analysis ◽  
Coronary Arterial Disease ◽  
History Of

Abstract Background and purpose Amiodarone is commonly use in patients with atrial fibrillation (AF), but the organ toxicity side effects limit its long-term use. We investigated the rates of and reasons for permanent amiodarone discontinuation among patients with AF in contemporary clinical practice. Methods A single-centre, ongoing, registry-based observational longitudinal study included consecutive AF patients prescribed with amiodarone in our hospital from January 2015 to December 2017. All patients underwent a loading protocol of 400–600 mg of amiodarone daily for 1–2 weeks, followed by 200–400mg daily for 4–8 weeks and 200mg daily or 1000mg weekly thereafter. Results Of 657 AF patients taking amiodarone (Mean age 62.2±11.0, female n=215 (32.6%), hypertension n=504 (76.7%), diabetes mellitus n=107 (16.3%), coronary arterial disease n=139 (19.8%), History of Myocardial infarction 86 (13.1%), Stroke/TIA 60 (9.1%), chronic kidney disease 157 (23.9%)), the drug was permanently discontinued in total of 248 patients (37.7%). The reasons for amiodarone discontinuation are shown in Figure. On multivariable Cox-regression analysis, physician's decision (HR 5.6; 95% CI 3.9–7.9, p<0.001) and amiodarone side effects (HR 3.9; 95% CI 2.9–5.1, p<0.001) were significantly associated with permanent amiodarone discontinuation. The overall time to discontinuation was 23.2±24.1 months. Compared with others, time to discontinuation was shorter in patients post AF ablation (17.3±21.3 vs 24.5±24.5, p=0.05), longer in those with AF progression (29.2±31.0 vs 20.9±20.3, p=0.014) and similar in patients with amiodarone side effects (23.7±17.7 vs 23.0±26.8, p=0.813). Pulmonary toxicity and proarrhythmia were not observed among study patients (Figure). Chart 1 Conclusion Our study showed that permanent discontinuation of amiodarone in contemporary clinical practice was due to the drug side effects in 12% of amiodarone-treated AF patients, occurring after a mean 2-year treatment course. The most prevalent side effect was thyroid dysfunction, whereas the prevalence of proarrhythmic effect was low. Notably, physician's fear of complications (which may not always be justified), also was an independent driver of permanent amiodarone discontinuation. More data are needed to inform optimal amiodarone use in AF patients in daily practice.

6083Amiodarone in contemporary clinical practice: the rates of and reasons for permanent drug discontinuation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Mihajlovic ◽  
A Mihajlovic ◽  
M Marinkovic ◽  
V Kovacevic ◽  
L Vajagic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Cox Regression ◽  
Daily Practice ◽  
University Hospital ◽  
Drug Discontinuation ◽  
Cox Regression Analysis ◽  
Artery Disease ◽  
Contemporary Practice ◽  
Ventricular Tachycardias

Abstract Background and purpose Amiodarone is the most effective antiarrhythmic drug, but its long-term use is limited by organ toxicity. We studied the rates of and factors associated with permanent amiodarone discontinuation in clinical practice. Methods An ongoing prospective single-centre registry-based observational study included consecutive amiodarone-naïve patients treated for cardiac arrhythmias in a university hospital between January 2015 and December 2017. Amiodarone was administered in loading doses of 400–800 mg daily for 1–2 weeks, followed by 200–400mg daily for 4–8 weeks and 200mg daily or 1000mg weekly thereafter. Results Of 1032 patients (mean age 61.5±11.4 years), 30.0% were females, and amiodarone was used for atrial fibrillation (AF, n=657, 63.7%), atrial flutter (n=187, 18.1%), other supraventricular arrhythmias (n=118, 11.4%), premature ventricular beats (n=239, 23.2%) or ventricular tachycardias (n=236, 22.9%). The most prevalent comorbidities were hypertension (n=761, 73.7%), coronary artery disease (n=283, 27.4%), heart failure (n=197, 19.2%), chronic kidney disease (n=266, 25.8%) and diabetes mellitus (n=196, 19.0%). Amiodarone was permanently discontinued due to its side effects in 103 patients (10.0%), physician's fear of complications in 73 (7.1%), patient preference in 4 (0.4%) or for miscellaneous reasons in 6 (0.6%). In another 161 patients (15.6%), the discontinuation was due to catheter ablation of index arrhythmia (n=90) or progression to permanent AF (n=71). On multivariable Cox-regression analysis, physician decision was significantly associated with amiodarone discontinuation (HR 4.2; 95% CI 3.3–5.5, p<0.001) along with the drug side effects (HR 3.0; 95% CI 2.4–3.8, p<0.001). Overall, amiodarone was permanently discontinued 347 patients (33.6%), after mean 21.4±25.2 months of treatment (median 13.0, IQR 203). The mean time to discontinuation was significantly shorter in patients with drug discontinued due to physician's decision (16.5±15.9 vs 22.7±26.9, p=0.013) and slightly longer in those with amiodarone side effects (24.9±25.8 vs 19.9±24.8 months, p=0.093) than in others. Side effects resulting in permanent amiodarone discontinuation were: hyperthyreosis (66, 6.4%), hypothyreosis (19, 1.8%), liver injury (5, 0.5%), bradycardia/AV block (9, 0.9%), QT prolongation (2, 0.2%) and corneal deposits (4, 0.4%). Pulmonary toxicity was not observed among study patients. Conclusion Our study showed that permanent amiodarone discontinuation in contemporary practice was due to its side effects in 10% of amiodarone-treated patients, occurring after a mean 2-year treatment course. The most prevalent side effect was thyroid dysfunction, whilst the prevalence of proarrhythmic effect was low. Notably, physician's fear of complications (which may not always be justified), was an independent driver of permanent amiodarone discontinuation. More data are needed to inform optimal amiodarone use in daily practice.

684 Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marrco Vitolo ◽  
Vincenzo Livio Malavasi ◽  
Marco Proietti ◽  
Igor Diemberger ◽  
Laurent Fauchier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Cardiac Troponins

Abstract Aims Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. To assess the factors associated with cTn testing in routine clinical practice and to evaluate the association of elevated levels of cTn with adverse outcomes in a large contemporary cohort of European AF patients. Methods and results Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into three groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), and (iii) cTn elevated (&gt;99th percentile). The composite outcome of any thromboembolism/any acute coronary syndrome (ACS)/cardiovascular (CV) death, defined as major adverse cardiovascular events (MACE) and all-cause death were the main endpoints. 10 445 (94.1%) AF patients were included in this analysis [median age 71 years, interquartile range (IQR): 63–77; males 59.7%]. cTn were tested in 2834 (27.1%). Overall, cTn was elevated in 904 (8.7%) and in-range in 1930 (18.5%) patients. Patients in whom cTn was tested tended to be younger (P &lt; 0.001) and more frequently presenting with first detected AF and atypical AF-related symptoms (i.e. chest pain, dyspnoea, or syncope) (P &lt; 0.001). On multivariable logistic regression analysis, female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease (CAD), and atypical AF symptoms were independently associated with cTn testing. After a median follow-up of 730 days (IQR: 692–749), 957 (9.7%) composite endpoints occurred while all-cause death was 9.5%. Kaplan–Meier analysis showed a higher cumulative risk for both outcomes in patients with elevated cTn levels (Figure) (Log Rank tests, P &lt; 0.001). On adjusted Cox regression analysis, elevated levels of cTn were independently associated with a higher risk for MACE [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.40–2.16] and all-cause death (HR 1.45, 95% CI: 1.21–1.74). Elevated levels of cTn were independently associated with a higher occurrence of MACE, all-cause death, any ACS, CV death and hospital readmission even after the exclusion of patients with history of CAD, diagnosis of ACS at discharge, those who underwent coronary revascularization during the admission and/or who were treated with oral anticoagulants plus antiplatelet therapy. Conclusions Elevated cTn levels were independently associated with an increased risk of all-cause mortality and adverse CV events, even after exclusion of CAD patients. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

scholarly journals Risk Factors for Atrial Fibrillation following a Cardiac Surgery

2021 ◽  
Author(s):  
Ibrahim Marai ◽  
Wiaam Khatib ◽  
Liza Grosman-Rimon ◽  
Shemy Carasso ◽  
Ali Sakhnini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cox Regression ◽  
Medical Center ◽  
Clinical Impact ◽  
Cox Regression Analysis ◽  
History Of ◽  
Vascular Accidents ◽  
Preoperative Factors

Background: Atrial fibrillation (AF) following cardiac surgery is common and has clinical impact on morbidity. The preoperative and intraoperative risk factors are still not well defined. The objective of the study was to examine preoperative and intraoperative risk factors for AF following cardiac surgery. Methods: A retrospective analysis of a database of cardiac surgeries was performed during 2017-2019 at Poriya Medical Center. Preoperative factors and intraoperative were recorded. Results: 208 patients were included in this analysis. Overall AF following cardiac surgery was detected in 50 (24%) patients. Of 175 patients who did not have history of AF prior to surgery, 27 (15.5%) had post-operative AF. In the 33 patients with previous AF, AF following surgery was detected in 23 (70%). Patients with AF following surgery who were older (66.2±8.0 vs. 60.7± 11.4 years, p=0.002), were treated more with anti-arrhythmic drugs (18.9% vs 4.5, p<0.001), and had higher rates of pre-operative AF (46% vs 6.3%, p=0.0001), prior cerebral vascular accidents (14% vs 4.4%, p=0.019), and prior valve replacement (10% vs 1.9%, p=0.009) compared to patients without AF following surgery. In multivariate Cox regression analysis, age (HR 1.04, CI 1.01-1.07, P=0.006) and history of preoperative AF (HR 6.01, CI 3.42-10.57, P<0.001) were predictors of AF following cardiac surgery. The probability of being free of postsurgical AF was 80% among patients without history of AF compared to 30% in patients with previous AF history (p<0.001). Conclusion: Preoperative AF and age were predictors of AF following cardiac surgery

scholarly journals Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-hui Li ◽  
Hai-yang Xie ◽  
Yan-qiao Chen ◽  
Zhong-jing Cao ◽  
Qing-hui Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Cavotricuspid Isthmus ◽  
Typical Atrial Flutter ◽  
Obstructive Sleep ◽  
History Of ◽  
New Onset

Aims: The aim was to describe the incidence of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) without history of AF and to identify risk factors for new-onset AF after the procedure.Methods: A total of 191 patients with typical AFL undergoing successful CTI ablation were enrolled. Patients who had history of AF, structural heart disease, cardiac surgery, or ablation or who received antiarrhythmic drug after procedure were excluded. Clinical and electrophysiological data were collected.Results: There were 47 patients (24.6%) developing new AF during a follow-up of 3.3 ± 1.9 years after CTI ablation. Receiver operating characteristic (ROC) curves indicated that the cut-off values of left atrial diameter (LAD) and CHA2DS2-VASc score were 42 mm and 2, with area under the curve of 0.781 and 0.550, respectively. The multivariable Cox regression analysis revealed that obstructive sleep apnea (OSA) [hazard ratio (HR) 3.734, 95% confidence interval (CI) 1.470–9.484, P = 0.006], advanced interatrial block (aIAB) (HR 2.034, 95% CI 1.017–4.067, P = 0.045), LAD &gt; 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score &gt; 2 (HR 2.123, 95% CI 1.118–4.034, P = 0.021) were independent risk factors of new-onset AF.Conclusion: A combination of OSA, aIAB, LAD &gt; 42 mm, and CHA2DS2-VASc &gt; 2 was a strongly high risk for new-onset AF after ablation for typical AFL, and it had significance in postablation management in clinical practice.

scholarly journals Main determinants of physician-driven amiodarone discontinuation in clinical practice

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Mihajlovic ◽  
A Mihajlovic ◽  
M Marinkovic ◽  
V Kovacevic ◽  
J Simic ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Side Effects ◽  
Cox Regression ◽  
Health Centre ◽  
Drug Discontinuation ◽  
Medical Reason ◽  
Cox Regression Analysis ◽  
Main Determinants ◽  
Cox Proportional Hazard Regression

Abstract Funding Acknowledgements Type of funding sources: None. Background Amiodarone is the most prescribed antiarrhythmic drug, but drug-related side effects sometimes result in drug discontinuation. Not infrequently, physicians discontinue amiodarone without a medical reason. We explored the determinants of such permanent drug discontinuation.  Methods  A single-centre, longitudinal study included consecutive patients newly prescribed or already taking amiodarone when first seen in our health centre from January 2013 to December 2017. Baseline data were retrieved from the hospital electronic database and patients were scheduled for a follow-up visit in January to March 2019.  Results  Of 1212 patients taking amiodarone (mean age 64.2 ±11.2 yrs; female n= 358, 29.5%; median follow-up 22.5 months), the drug was permanently discontinued in 489 (40.3 %), see Figure. On univariate Cox regression analysis, female sex (HR 1.55; 95%CI 1.0-2.3; p = 0.032), non-multimorbidity (2.9; 2.0-4.3; p &lt; 0.001), LV EF (1.0; 1.0-1.1; p &lt; 0.001), NOAC therapy (1.9; 1.2-3.0; p = 0.003) and AF ablation (2.7; 1.5-4.6; P &lt; 0.001) were associated with amiodarone discontinuation. Age (0.9; 0.9-0.9; p &lt; 0.001), CAD (0.3; 0.2-0.5; p &lt; 0.001), HF (0.5; 0.3-0.9; p = 0.020), ventricular arrhythmias (0.1; 0.0-0.3; p &lt; 0.001), stroke (0.2; 0.1-0.9; p = 0.045), CKD (0.5; 0.3-0.9; p = 0.011), ICD (0.1; 0.0-0.6; P = 0.014), LV diastolic (0.9; 0.9-0.9; p = 0.001) and systolic diameter (0.9; 0.9-0.9; p &lt; 0.001), polypharmacy (0.5; 0.3-0.7; P &lt; 0.001), VKA therapy (0.6; 0.4-0.9; p = 0.027), aspirin (0.57; 0.4-0.9; p = 0.011), loop diuretic (0.5; 0.3-0.7; p &lt; 0.001), spironolactone (0.4; 0.2-0.7; p &lt; 0.001) and statin (0.6; 0.4-0.9; p = 0.009) therapy were associated with drug continuation. Multivariable risk factors for amiodarone discontinuation are showed in Table.  Conclusion Study showed that within the first two years of treatment, despite persistent indication, amiodarone was discontinued in 1 out of 10 patients in the absence of side effects, mostly in younger patients with less comorbidities, which may not always be justified. There is a need for qualitative research to elucidate the reasons for such physicians’ decisions. Table.Multivariable Cox Proportional HAZARD Regression analysis of permanent Amiodarone discontinuation due to physician decisionVariableHR95% CIP valueAge0.9700.95-0.990.003VT/VF/electrical storm0.1390.04-0.450.001VKA therapy0.5980.38-0.940.026Ablation of AF2.5391.38-4.690.003Number of comorbidities ≤32.0241.26-3.270.004VT ventricular tachycardia; VF: ventricular fibrillation.Abstract Figure.

Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.L Malavasi ◽  
E Fantecchi ◽  
V Tordoni ◽  
L Melara ◽  
A Barbieri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Factors Affecting ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
History Of ◽  
Unselected Population ◽  
Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc &lt;0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (&gt;42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score &gt;2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs &gt;2 led to a statistically significant difference (χ2=16.080 p&lt;0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

Long-term outcomes of kidney donors with fibromuscular dysplasia

2021 ◽  
Author(s):  
Horacio E Adrogue ◽  
Andrew Evans ◽  
Dina N Murad ◽  
Hana Nguyen ◽  
Sean A Hebert ◽  
...  
Keyword(s):  
Fibromuscular Dysplasia ◽  
Cox Regression ◽  
Arterial Disease ◽  
Similar Proportion ◽  
Long Term Outcomes ◽  
No Donor ◽  
Kidney Donors ◽  
Cox Regression Analysis ◽  
Donor Evaluation

Abstract Background Fibromuscular dysplasia (FMD) is a non-atherosclerotic systemic arterial disease that is not infrequently discovered during kidney donor evaluation. Current guidelines do not provide recommendations regarding the use of kidneys from donors with FMD and there is a paucity of data on the outcomes of these donors. Methods The Renal and Lung Living Donor Evaluation (RELIVE) study addressed long-term outcomes of 8922 kidney donors who donated between 1963 and 2007. We compared the development of hypertension, cardiovascular disease (CVD), proteinuria and reduced estimated glomerular filtration rate (eGFR) in 113 kidney donors with FMD discovered during donor evaluation versus 452 propensity score matched donors without FMD. Outcomes modeling with logistic and Cox regression analysis and Kaplan–Meier statistics were performed. Results Donors with FMD were older (51 versus 39 years), were more likely to be women (80% versus 56%) and had a higher systolic blood pressure at donation (124.7 versus 121.3 mmHg) (P &lt; 0.05 for all). After a mean ± standard deviation follow-up of 15.5 ± 8.9 years, a similar proportion of donors with and without FMD were alive, and developed hypertension (22.2% versus 19.8%), proteinuria (20.6% versus 13.7%) and CVD (13.3% versus 13.5%). No donor with FMD developed an eGFR &lt;30 mL/min/1.73 m2 or end-stage kidney disease. The multivariable risk of mortality, CVD and renal outcomes in donors with FMD was not elevated. Conclusions Kidney donors with FMD appear to do well, do not appear to incur increased risks of hypertension, proteinuria, CVD or reduced eGFR, and perhaps carefully selected candidates with FMD can safely donate as long as involvement of other vascular beds is ruled out.

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Wesley T O’Neal ◽  
J’Neka Claxton ◽  
Richard MacLehose ◽  
Lin Chen ◽  
Lindsay G Bengtson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Increased Risk ◽  
History Of ◽  
Reduced Risk ◽  
History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jun Young Lee ◽  
Jae Won Yang ◽  
Jae Seok Kim ◽  
Seong Ok Choi ◽  
Byoung Geun Han
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Dialysis Patients ◽  
Dialysis Therapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Stage Renal Disease ◽  
End Stage ◽  
Risk And Benefit

Abstract Background and Aims Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF. Method By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF. Results Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597). Conclusion Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.

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