Polypharmacy and adverse events in atrial fibrillation: Main cause or reflection of multimorbidity?

Martinez Montesinos, Lorena; Rivera Caravaca, José Miguel; Agewall, S; Soler Espejo, Eva; Lip, Gregory Y; Marin, Francisco; Roldán Schilling, Vanessa

Publication:
Polypharmacy and adverse events in atrial fibrillation: Main cause or reflection of multimorbidity?

dc.contributor.author	Martinez Montesinos, Lorena
dc.contributor.author	Rivera Caravaca, José Miguel
dc.contributor.author	Agewall, S
dc.contributor.author	Soler Espejo, Eva
dc.contributor.author	Lip, Gregory Y
dc.contributor.author	Marin, Francisco
dc.contributor.author	Roldán Schilling, Vanessa
dc.contributor.department	Medicina
dc.date.accessioned	2024-02-08T09:05:49Z
dc.date.available	2024-02-08T09:05:49Z
dc.date.issued	2023
dc.description	©2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Published version of a Published Work that appeared in final form in Biomedicine and Pharmacotherapy. To access the final edited and published work see https://doi.org/10.1016/j.biopha.2022.114064	es
dc.description.abstract	Background: Previous evidence indicated that atrial fibrillation (AF) patients with polypharmacy presented increased probability of adverse events. We investigated the prevalence of polypharmacy, risk factors for polypharmacy, and the impact of polypharmacy in clinical outcomes in a 'real-world' cohort of AF patients starting vitamin K antagonists (VKAs). Methods: Prospective study including AF outpatients starting VKA therapy from July, 2016 to June, 2018. At inclusion, all concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥ 5 concomitant drugs. During 2-years of follow-up, ischemic strokes/transient ischemic attacks (TIAs), fatal/nonfatal myocardial infarctions (MIs), bleeding events, venous thromboembolisms, and all-cause deaths were recorded. Results: 1050 patients (51.5 % females, median age 77 [69-83] years) were included, and the prevalence of polypharmacy was 32.9 % (345). Female sex (OR 1.5; 95 % CI 1.11-2.03), hypertension (OR 2.53; 95 % CI 1.51-4.22), diabetes (OR 3.11; 95 % CI 2.31-4.17), vascular disease (OR 3.08; 95 % CI 2.19-4.33), heart failure (OR 1.86; 95 % CI 1.35-2.58) and dyslipidemia (OR 2.61; 95 % CI 1.9-3.58) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence of major bleeding, net clinical outcomes (composite of major bleeding, ischemic stroke/TIA, and mortality), MACE (composite of ischemic stroke/TIA, MI, and cardiovascular death), and composite thrombotic/thromboembolic events; being an independent risk factor for major bleeding (HR 1.77, 95 % CI 1.07-2.92), and composite thrombotic/thromboembolic events (HR 1.55, 95 % CI 1.05-2.31). Conclusion: In this "real world" AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with bleeding and thromboembolic events.	es
dc.format	application/pdf	es
dc.format.extent	6	es
dc.identifier.citation	Biomedicine and Pharmacotherapy. 2023 Feb 158:114064.
dc.identifier.doi	10.1016/j.biopha.2022.114064
dc.identifier.issn	0753-3322
dc.identifier.uri	http://hdl.handle.net/10201/138956
dc.language	eng	es
dc.relation	This work was supported by the Spanish Ministry of Economy, Industry, and Competitiveness, through the Instituto de Salud Carlos III after independent peer review (research grant: PI17/01375 co-financed by the European Regional Development Fund) and group CB16/11/00385 from CIBERCV.	es
dc.rights	info:eu-repo/semantics/openAccess	es
dc.rights	Attribution-NonCommercial-NoDerivatives 4.0 Internacional	*
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/4.0/	*
dc.subject	Fibrilacion auricular	es
dc.subject	Polifarmacia	es
dc.title	Polypharmacy and adverse events in atrial fibrillation: Main cause or reflection of multimorbidity?	es
dc.type	info:eu-repo/semantics/article	es
dspace.entity.type	Publication	es