Relationship of adverse events to quality of anticoagulation control in atrial fibrillation patients with diabetes: Real-world data from the FANTASIIA registry.



García-Fernández, Amaya, Esteve-Pastor, María Asunción, Rabadán, Inmaculada Roldán, Muñiz, Javier, Ruiz Ortiz, Martín, Cequier, Ángel, Bertomeu-Martínez, Vicente, Badimón, Lina, Otero, Déborah, Anguita, Manuel
et al (show 2 more authors) (2020) Relationship of adverse events to quality of anticoagulation control in atrial fibrillation patients with diabetes: Real-world data from the FANTASIIA registry. Annals of medicine.

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Abstract

BACKGROUND:Atrial fibrillation (AF) patients with diabetes (DM) are at increased risk of cardiovascular events and have higher related morbidity and mortality. PURPOSE:To compare clinical characteristics, cardiovascular adverse outcomes and quality of anticoagulation in AF patients with and without DM. METHODS:AF patients from the Spanish national, multicentric, prospective FANTASIIA registry were included. Patients received oral anticoagulation (vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC)) for at least 6 months before inclusion. Baseline clinical characteristics and comorbidities were recorded. After 2-years follow-up, the association between adverse events and the presence of DM was evaluated. RESULTS:1956 individuals (mean age 73.8 ± 9.5 years, 56% male) were analysed; of these, 574 (29.3%) had DM. Diabetic patients had increased prevalence of other risk factors such as hypertension (90.6% vs 76.1%; p < 0.001), renal disease (21.4% vs 15.9%; p < 0.001) and heart failure (39.1% vs 24.7%; p < 0.001). A rhythm control strategy was applied less often in diabetic patients vs non-diabetics (33.6% vs 40.1%; p = 0.007).After a median follow-up of 1077 days (IQR 766-1113 days), diabetic patients had higher risk of total mortality (16.9%/year vs 11.4%/year; p < 0.001), cardiovascular mortality (9.1%/year vs 3.9%/year; p < 0.001) and MACE (12.9%/year vs 6.8%/year; p < 0.001). Patients with DM had increased total mortality risk [HR 1.58 (95IC% 1.20-2.07); p < 0,001], cardiovascular mortality [HR 2.40 (95IC% 1.17-3.53); p < 0.001] and MACE [HR 2.03 (IC95% 1.47-2.80); p < 0.001]. DM patients had poorer anticoagulation control (time in therapeutic range: 58.52 ± 24.37% vs 62.68 ± 25.31%; p = 0.002). Among diabetic individuals, those with lower TTR showed higher risk of cardiovascular death [(14.12 vs 4.89%;p = 0.001 for TTR <65 vs ≥65%);(13.36 vs 4.55%;p = 0.003 for TTR <70 vs ≥70%)] and MACE [(16.79 vs 9.78%;p = 0.03 for TTR <65 vs ≥65%);(16.44 vs 9.09%;p = 0.03 for TTR <70 vs ≥70%)]. Multivariate analysis showed an independent association between the presence of DM and cardiovascular mortality [HR 1.73 (IC95% 1.07-2.80); p = 0.024]. CONCLUSION:Diabetic patients with AF have more associated comorbidities. Quality of anticoagulation control with vitamin K antagonists in these subjects was poorer than in non-diabetic patients. Lower TTR was associated with cardiovascular death and MACE in diabetic patients. The risk of cardiovascular outcomes (total mortality, cardiovascular mortality and MACE events) was higher, with an independent association between DM and increased mortality risk.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Oral anticoagulation, Diabetes mellitus, Risk factors
Depositing User: Symplectic Admin
Date Deposited: 12 Aug 2020 10:25
Last Modified: 03 Sep 2022 12:10
DOI: 10.1080/07853890.2020.1778176
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3097279