Non-embolic outcomes in patients with cardiovascular disease and atrial fibrillation treated with rivaroxaban

Francisco Marı́n; Marcelo Sanmartı́n; Gonzalo Barón‐Esquivias; Vivencio Barrios; Iñaki Lekuona; Alejandro Pérez Cabeza; Jaime Masjuán; Esther Recalde Del Vigo; José Manuel Vázquez‐Rodríguez; Román Freixa‐Pamias; Vanessa Roldán; Fernando Arribas; Manuel Anguita Sánchez

doi:10.57264/cer-2022-0049

February 21, 2023Journal of Comparative Effectiveness ResearchOpen Access

Non-embolic outcomes in patients with cardiovascular disease and atrial fibrillation treated with rivaroxaban

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Why the study?

It is not well known how comorbidities may change the prognosis of AF patients, prompting this study to analyze the impact of cardiovascular disease.

Does the presence of vascular disease increase the risk of adverse cardiovascular outcomes in patients with atrial fibrillation treated with rivaroxaban?

Structured PICO

Does the presence of vascular disease increase the risk of adverse cardiovascular outcomes in patients with atrial fibrillation treated with rivaroxaban?

P

Population

1,433 patients with atrial fibrillation taking rivaroxaban for ≥6 months

I

Intervention

Presence of vascular disease (including coronary artery disease, peripheral artery disease, or aortic plaque)

C

Comparator

Absence of vascular disease

O

Outcome

Major adverse cardiovascular events, cardiovascular death, and thromboembolic eventshard clinical

In patients with atrial fibrillation treated with rivaroxaban, the presence of concomitant vascular disease significantly increases the risk of major adverse cardiovascular events and cardiovascular death.

Implication

Vascular disease signals elevated risk in rivaroxaban-treated AF; extends observational cohorts but leaves open whether it should modify therapy.

Abstract

Aim: It is not well known how comorbidities may change the prognosis of atrial fibrillation (AF) patients. This study was aimed to analyze the impact of cardiovascular disease on this population. Materials & methods: EMIR was a multicenter, prospective study, including 1433 AF patients taking rivaroxaban for ≥6 months. Data were analyzed according to the presence of vascular disease. Results: Coronary artery disease was detected in 16.4%, peripheral artery disease/aortic plaque in 6.7%, vascular disease in 28.3%. Patients with coronary artery disease had higher rates (per 100 patient-years) of major adverse cardiovascular events (2.98 vs 0.71; p < 0.001) and cardiovascular death (1.79 vs 0.41; p = 0.004). Those with vascular disease had higher rates of thromboembolic events (1.47 vs 0.44; p = 0.007), major adverse cardiovascular events (2.03 vs 0.70; p = 0.004), and cardiovascular death (1.24 vs 0.39; p = 0.025). Patients with peripheral artery disease/aortic plaque had similar rates. Conclusion: AF patients with vascular disease have a higher risk of non-embolic outcomes.