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Anticoagulation use only 60% in patients with AF, ischemic cardiomyopathy
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Among patients with atrial fibrillation and HF, those with ischemic cardiomyopathy less often received anticoagulant therapy compared with patients with nonischemic cardiomyopathy, according to findings published in JAMA Cardiology.
In the cohort, those with ischemic cardiomyopathy had higher rates of all-cause and CVD death than those with nonischemic cardiomyopathy.
Ramon Corbalan, MD, and colleagues assessed treatment strategies and 1-year clinical outcomes of antithrombotic and congestive HF therapies for patients with newly diagnosed AF with concomitant congestive HF. Patients were stratified by whether they had ischemic cardiomyopathy or nonischemic cardiomyopathy.
“Treatment of both conditions implies use of specific drugs for [congestive] HF plus antithrombotic agents for stroke prevention,” Corbalan, professor of medicine in the division of cardiovascular diseases at Catholic University School of Medicine in Chile, and colleagues wrote. “In addition, management strategies and outcomes may be affected by the etiology of [congestive] HF, namely ischemic cardiomyopathy or nonischemic cardiomyopathy, because the prescription of antithrombotic therapies might be different and could affect prognosis in terms of death stroke/systemic embolism and bleeding.”
The researchers analyzed data from 11,738 patients in the GARFIELD-AF registry aged at least 18 years with newly diagnosed AF with a duration of 6 weeks or less and at least one investigator-determined stroke risk factor.
Among the cohort, 40.2% had ischemic cardiomyopathy (mean age, 70 years; 60% men) and the rest had nonischemic cardiomyopathy (mean age, 70 years; 55% men), Corbalan and colleagues wrote.
Prescription of oral anticoagulant and antiplatelet drugs were not balanced between groups, the researchers wrote. Oral anticoagulants with or without antiplatelet drugs were used in 60.1% of patients with ischemic cardiomyopathy and 73.7% of patients with nonischemic cardiomyopathy.
Antiplatelets alone were prescribed in 34.4% of patients with ischemic cardiomyopathy and 15.5% of patients with nonischemic cardiomyopathy, Corbalan and colleagues wrote.
The use of ACE inhibitors/angiotensin receptor blockers (72.6% vs. 60.3%) and beta-blockers (63.3% vs. 53.2%) was higher in patients with ischemic cardiomyopathy compared with patients with nonischemic cardiomyopathy, the researchers wrote.
All-cause death was significantly higher in the ischemic cardiomyopathy group (10.2 per 100 patient-years; 95% CI, 9.2-11.1) compared with the nonischemic cardiomyopathy group (7 per 100 patient-years; 95% CI, 6.4-7.6), Corbalan and colleagues wrote.
CV death was also higher in the ischemic cardiomyopathy group (5.1 per 100 patient-years; 95% CI, 4.5-5.9) compared with the nonischemic cardiomyopathy group (2.9 per 100 patient-years; 95% CI, 2.5-3.4).
The rate of stroke/systemic embolism was numerically higher in the ischemic cardiomyopathy group (2 per 100 patient-years; 95% CI, 1.6-2.5) compared with the nonischemic cardiomyopathy group (1.5 per 100 patient-years; 95% CI, 1.3-1.9).
The rate of major bleeding was also significantly higher in the ischemic cardiomyopathy group (1.1 per 100 patient-years; 95% CI, 0.8-1.4) compared with the nonischemic cardiomyopathy group (0.7 per 100 patient-years; 95% CI, 0.5-0.9), the researchers wrote.
“These findings should prompt physicians to opt for active treatment of both AF and [congestive] HF, particularly in patients with [ischemic cardiomyopathy],” they wrote. – by Earl Holland Jr.
Disclosures: Corbalan reports no relevant financial disclosures. Please see the study for all authors’ relevant financial disclosures.
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