Table 3.
HRs and 95% CIsa of Selected Outcomes After 30 Days Following AF Diagnosis. Comparing AF Treatments by Polypharmacy Use Among AF Patients Aged ≥75 Years, MarketScan, 2007–2015
| HR (95% CI) | Stroke | Major Bleeding | Heart Failure | |||
|---|---|---|---|---|---|---|
| No Polypharmacy | Polypharmacy | No Polypharmacy | Polypharmacy | No Polypharmacy | Polypharmacy | |
| OAC vs No OAC (N=338 810) | ||||||
| No OAC | 1 | 1 | 1 | 1 | 1 | 1 |
| OAC | 0.92 (0.86–0.98) | 0.89 (0.84–0.95) | 1.32 (1.25–1.39) | 1.19 (1.14–1.24) | 1.09 (1.04–1.15) | 1.07 (1.04–1.11) |
| P for interaction | 0.51 | 0.03 | 0.82 | |||
| Warfarin vs dabigatran vs rivaroxaban vs apixaban (n=97 335) | ||||||
| Warfarin | 1 | 1 | 1 | 1 | 1 | 1 |
| Dabigatran | 1.16 (0.92–1.48) | 1.06 (0.84–1.32) | 0.87 (0.72–1.05) | 0.96 (0.83–1.10) | 0.68 (0.56–0.84) | 0.87 (0.77–0.99) |
| Rivaroxaban | 0.79 (0.57–1.11) | 0.90 (0.68–1.21) | 0.95 (0.77–1.17) | 1.08 (0.92–1.26) | 0.87 (0.71–1.07) | 0.81 (0.70–0.95) |
| Apixaban | 0.65 (0.33–1.25) | 0.56 (0.30–1.04) | 0.65 (0.42–1.00) | 0.76 (0.56–1.03) | 0.79 (0.56–1.12) | 0.81 (0.63–1.04) |
| P for interaction | 0.87 | 0.93 | 0.57 | |||
| Rhythm control vs rate control (n=163 506) | ||||||
| Rate control | 1 | 1 | 1 | 1 | 1 | 1 |
| Rhythm control | 0.78 (0.64–0.93) | 0.79 (0.68–0.93) | 0.85 (0.74–0.98) | 0.93 (0.84–1.03) | 0.87 (0.76–0.99) | 0.98 (0.91–1.07) |
| P for interaction | 0.85 | 0.20 | 0.02 | |||
Polypharmacy defined as ≥5 prescriptions at the time of AF diagnosis (polypharmacy definition 1). AF indicates atrial fibrillation; HR, hazard ratio; and OAC, oral anticoagulant.
Models adjusted for age, sex, frailty index, comorbidities (congestive heart failure, coronary artery disease, hyperlipidemia, stroke, arthritis, myocardial infarction, peripheral artery disease, gastrointestinal bleeding, cerebral bleeding, other bleeding, anemia, coagulopathy, mood disorder, cognitive impairment, liver disease, alcohol abuse, asthma, cancer, chronic kidney disease, chronic pulmonary disease, dementia, depression, diabetes mellitus, hepatitis, osteoporosis, schizophrenia, and substance abuse), and AF treatment (oral anticoagulation, antiarrhythmic drugs, catheter ablation, cardioversion, rate control therapy).