학술논문
Multi-morbidity, Anti-thrombotic Treatment and Mortality Among the Elderly NVAF Patients from the KERALA-AF Registry.
Document Type
Article
Author
Bahuleyan, C. G.; Lip, Gregory Y. H.; Namboodiri, Narayanan; Jabir, A.; Koshy, A. George; Zachariah, Geevar; Babu, Shifas M.; Venugopal, K.; Punnose, Eapen; Natarajan, K. U.; Joseph, Johny; Nambiar, C. Ashokan; Jayagopal, P. B.; Mohanan, P. P.; George, Raju; Unni, Govindan; Sajeev, C. G.; Syam, N.; Roby, Anil; Daniel, Rachel
Source
Subject
*ATRIAL fibrillation
*OLDER patients
*THROMBOTIC thrombocytopenic purpura treatment
*ANTICOAGULANTS
*FIBRINOLYTIC agents
*KAPLAN-Meier estimator
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Language
ISSN
2831-7335
Abstract
Background and Aim: Reports on patients with nonvalvular atrial fibrillation (NVAF), particularly in the elderly, are few from India. This paper focuses on multimorbidity pattern, antithrombotic treatment and mortality of elderly NVAF patients from the state of Kerala, India. Methods: Clinical details of NVAF patients of age = 75 years from the cohort of KERALA-AF registry were analyzed for pattern of multimorbidity, antithrombotic treatment and one-year mortality. Results: The study comprised 753 patients with a median age of 80 years (IQR = 77-84), 53.5% being male. Multimorbidity was present in 94.5% of patients. Hypertension was the most common risk factor (74.4 %, n = 560) and chronic kidney disease was the major coexisting disease (78.9%, n = 594). Based on the number of comorbidities present, patients were grouped into three groups: < 3 comorbidities (18.1%), 3-5 comorbidities (63.9%), and > 5 comorbidities (17.6%). Oral anticoagulant therapy (OAC) was received by 62.5% (n = 472) of patients, mostly Vitamin K antagonist (VKA). Direct oral anticoagulants (DOAC) were used in 11.3% of patients. Antiplatelet therapy was used in 60.6% (n = 458) and the most commonly used antiplatelet was clopidogrel (44.6%). No antithrombotic treatment was used in 12.0% of patients (n = 91). One-year all-cause mortality was 19.6% (n = 148), higher in women but not statistically significant (p = 0.06). Kaplan-Meier survival curve indicated better one-year survival for patients who received OAC treatment (log rank test p < 0.0001, HR = 0.49 (95% CI = 0.35, 0.68), concordance = 0.58). Multivariate cox proportional hazards regression model showed OAC treatment (HR, 0.5; 95% CI, 0.36-0.7, P < 0.001) and age more than 80 years (HR, 1.53; 95% CI, 1.11 -2.1, P < 0.01) as predictors of one-year mortality. Mortality was not significantly different among the groups with different clustering of multimorbidity. Conclusion: Use of oral anticoagulation was associated with a reduced risk of mortality among elderly NVAF patients in the KERALA-AF Registry. However, more than one-third of elderly NVAF patients did not receive OAC, which calls for increased sensitization and training of treating doctors regarding optimal use of OAC in the elderly NVAF patients. Funding: The study received funding from the Cardiological Society of India-Kerala Chapter (CSI-K). [ABSTRACT FROM AUTHOR]