Key result
Polypharmacy is linked to ~23-point higher oral anticoagulation use in atrial fibrillation.
Why the study?
The impact of multimorbidity and polypharmacy on AF management, along with factors associated with polypharmacy and OAC use, required investigation in clinical practice.
What is the impact of multimorbidity and polypharmacy on oral anticoagulation use in patients with non-valvular atrial fibrillation?
Observational (n=2,712)
Yes
What is the impact of multimorbidity and polypharmacy on oral anticoagulation use in patients with non-valvular atrial fibrillation?
Multimorbidity and polypharmacy are highly prevalent in AF patients and are associated with suboptimal use of oral anticoagulation, particularly in older patients and those treated in non-emergency settings.
Answers are grounded in this paper and cite their sources.
Multimorbidity and polypharmacy in AF associate with higher OAC prescription rates; leaves open their net impact on outcomes and optimal decision-making.
OBJECTIVE: We investigated the impact of multimorbidity and polypharmacy on the management of atrial fibrillation (AF) patients in clinical practice and assessed factors associated with polypharmacy and oral anticoagulation (OAC) use in AF patients with multimorbidity and polypharmacy. METHODS: A 14-week prospective study of consecutive non-valvular AF patients was performed in seven Balkan countries. RESULTS: Of 2712 consecutive patients, 2263 patients (83.4%) had multimorbidity (AF + ≥2 concomitant diseases) and 1505 patients (55.5%) had polypharmacy. 1416 (52.2%) patients had both multimorbidity and polypharmacy. Overall, 1164 (82.2%) patients received OAC, 200 (14.1%) patients received antiplatelet drugs alone and 52 (3.7%) patients had no antithrombotic therapy (AT). Non-emergency centre and paroxysmal AF were significantly associated with OAC non-use in patients with multimorbidity, whilst age ≥80 years and non-emergency centre were identified to be independent predictors of OAC non-use in patients with polypharmacy. CONCLUSIONS: Multimorbidity and polypharmacy were common among AF patients in our study. AT was suboptimal and approximately 18% of multimorbid patients with polypharmacy were not anticoagulated. Pattern of AF and non-emergency centre were associated with OAC non-use in AF patients with multimorbidity, whilst non-emergency centre and age ≥80 years were associated with OAC non-use in AF patients with polypharmacy. Key Message Multimorbidity and polypharmacy are common among patients with AF. Antithrombotic therapy was suboptimal in AF patients with multimorbidity and polypharmacy. Approximately, 18% of multimorbid patients with polypharmacy were not anticoagulated.
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Kozieł et al. (2020) conducted an observational in Atrial Fibrillation (n=2,712). Polypharmacy vs. No polypharmacy was evaluated on Oral anticoagulation (OAC) use (p=<0.001). Multimorbidity and polypharmacy were highly prevalent among patients with atrial fibrillation, with oral anticoagulation prescribed to 82.5% of patients with polypharmacy compared to 59.9% of those without polypharmacy.
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