TY - JOUR
T1 - Clinical Implications of Polypharmacy for Patients with New-Onset Atrial Fibrillation Based on Real-World Data
T2 - Observations from the Korea National Health Insurance Service Data
AU - Kim, Hong Ju
AU - Yang, Pil Sung
AU - Kim, Daehoon
AU - Sung, Jung Hoon
AU - Jang, Eunsun
AU - Yu, Hee Tae
AU - Kim, Tae Hoon
AU - Pak, Hui Nam
AU - Lee, Moon Hyoung
AU - Joung, Boyoung
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/5
Y1 - 2024/5
N2 - Background: Polypharmacy is commonly observed in atrial fibrillation (AF) and is associated with poorer clinical outcomes. Our study aimed to elucidate the polypharmacy prevalence, its associated risk factors, and its relationship with adverse clinical outcomes using a ‘real-world’ database. Methods: This study included 451,368 subjects without prior history of AF (median age, 54 [interquartile range, 48.0–63.0] years; 207,748 [46.0%] female) from the Korea National Health Insurance Service-Health Screening (NHIS-HealS) database between 2002 and 2013. All concomitant medications prescribed were collected, and the intake of five or more concomitant drugs was defined as polypharmacy. During the follow-up, all-cause death, major bleeding events, transient ischemic attack (TIA) or ischemic stroke, and admission due to worsened heart failure were recorded. Results: Based on up to 7.7 (6.8–8.3) years of follow-up and 768,306 person-years, there were 12,241 cases of new-onset AF identified. Among patients with new-onset AF (40.0% females, median age 63.0 [54.0–70.0] years), the polypharmacy prevalence was 30.9% (3784). For newly diagnosed AF, factors, such as advanced age (with each increase of 10 years, odds ratios (OR) 1.32, 95% confidence interval (CI) 1.26–1.40), hypertension (OR 4.00, 95% CI 3.62–4.43), diabetes mellitus (OR 3.25, 95% CI 2.86–3.70), chronic obstructive pulmonary disease (COPD) (OR 3.00, 95% CI 2.51–3.57), TIA/ischemic stroke (OR 2.36, 95% CI 2.03–2.73), dementia history (OR 2.30, 95% CI 1.06–4.98), end-stage renal disease (ESRD) or chronic kidney disease (CKD) (OR 1.97, 95% CI 1.38–2.82), and heart failure (OR 1.95, 95% CI 1.69–2.26), were found to be independently correlated with the incidence of polypharmacy. Polypharmacy significantly increased the incidence and risk of major bleeding (adjusted hazard ratio (aHR) 1.26, 95% CI 1.12–1.41). The study observed a statistically significant increase in the incidence of all-cause mortality, however, the risk for all-cause mortality elevated but did not show significance (aHR 1.11, 95% CI 0.99–1.24). The risk of stroke and admission for heart failure did not change with polypharmacy. Conclusions: In our investigation using data from a nationwide database, polypharmacy was widespread in new-onset AF population and was related to major bleeding events. However, polypharmacy does not serve as an independent risk factor for adverse outcomes, with exception of major bleeding event. For AF patients, ensuring tailored medication for comorbidities as well as reducing polypharmacy are essential considerations.
AB - Background: Polypharmacy is commonly observed in atrial fibrillation (AF) and is associated with poorer clinical outcomes. Our study aimed to elucidate the polypharmacy prevalence, its associated risk factors, and its relationship with adverse clinical outcomes using a ‘real-world’ database. Methods: This study included 451,368 subjects without prior history of AF (median age, 54 [interquartile range, 48.0–63.0] years; 207,748 [46.0%] female) from the Korea National Health Insurance Service-Health Screening (NHIS-HealS) database between 2002 and 2013. All concomitant medications prescribed were collected, and the intake of five or more concomitant drugs was defined as polypharmacy. During the follow-up, all-cause death, major bleeding events, transient ischemic attack (TIA) or ischemic stroke, and admission due to worsened heart failure were recorded. Results: Based on up to 7.7 (6.8–8.3) years of follow-up and 768,306 person-years, there were 12,241 cases of new-onset AF identified. Among patients with new-onset AF (40.0% females, median age 63.0 [54.0–70.0] years), the polypharmacy prevalence was 30.9% (3784). For newly diagnosed AF, factors, such as advanced age (with each increase of 10 years, odds ratios (OR) 1.32, 95% confidence interval (CI) 1.26–1.40), hypertension (OR 4.00, 95% CI 3.62–4.43), diabetes mellitus (OR 3.25, 95% CI 2.86–3.70), chronic obstructive pulmonary disease (COPD) (OR 3.00, 95% CI 2.51–3.57), TIA/ischemic stroke (OR 2.36, 95% CI 2.03–2.73), dementia history (OR 2.30, 95% CI 1.06–4.98), end-stage renal disease (ESRD) or chronic kidney disease (CKD) (OR 1.97, 95% CI 1.38–2.82), and heart failure (OR 1.95, 95% CI 1.69–2.26), were found to be independently correlated with the incidence of polypharmacy. Polypharmacy significantly increased the incidence and risk of major bleeding (adjusted hazard ratio (aHR) 1.26, 95% CI 1.12–1.41). The study observed a statistically significant increase in the incidence of all-cause mortality, however, the risk for all-cause mortality elevated but did not show significance (aHR 1.11, 95% CI 0.99–1.24). The risk of stroke and admission for heart failure did not change with polypharmacy. Conclusions: In our investigation using data from a nationwide database, polypharmacy was widespread in new-onset AF population and was related to major bleeding events. However, polypharmacy does not serve as an independent risk factor for adverse outcomes, with exception of major bleeding event. For AF patients, ensuring tailored medication for comorbidities as well as reducing polypharmacy are essential considerations.
KW - all-cause mortality
KW - arial fibrillation
KW - heart failure admission
KW - major bleeding
KW - polypharmacy
KW - real-world data
KW - stroke
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U2 - 10.31083/j.rcm2505164
DO - 10.31083/j.rcm2505164
M3 - Article
AN - SCOPUS:85194771700
SN - 1530-6550
VL - 25
JO - Reviews in Cardiovascular Medicine
JF - Reviews in Cardiovascular Medicine
IS - 5
M1 - 164
ER -