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Cardiovascular Outc...
Cardiovascular Outcomes According to Polypharmacy and Drug Adherence in Patients with Atrial Fibrillation on Long-Term Anticoagulation (from the RE-LY Trial)
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- Millenaar, Dominic (author)
- Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany.
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- Schumacher, Helmut (author)
- Ingelheim Rhein, Rhineland Palatinate, Germany.
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- Brueckmann, Martina (author)
- Boehringer Ingelheim Int GmbH, Med CardioMetab & Resp, Binger Str 173, Ingelheim, Rhineland Palat, Germany.;Univ Klinikum Mannheim, Med Fak Mannheim, Theodor Kutzer Ufer 1-3, Mannheim, Baden Wurttembe, Germany.
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- Eikelboom, John W. (author)
- McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada.
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- Ezekowitz, Michael (author)
- Jefferson Univ, Sidney Kimmel Med Coll, Philadelphia, PA USA.;Lankenau Inst Med Res, Wynnewood, PA USA.;Heart Ctr, Wynnewood, PA USA.
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- Slawik, Jonathan (author)
- Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany.
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- Ewen, Sebastian (author)
- Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany.
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- Ukena, Christian (author)
- Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany.
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Science for Life Laboratory, SciLifeLab,Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden.;Uppsala Univ, Dept Med Sci, Cardiol, Uppsala, Sweden.
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- Connolly, Stuart (author)
- McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada.
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- Yusuf, Salim (author)
- McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada.
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- Bohm, Michael (author)
- Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany.
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Klin Innere Med III Kardiol Angiol Internist Inte, Homburg, Germany Ingelheim Rhein, Rhineland Palatinate, Germany. (creator_code:org_t)
- EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2021
- 2021
- English.
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In: American Journal of Cardiology. - : EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. - 0002-9149 .- 1879-1913. ; 149, s. 27-35
- Related links:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Prevalence of atrial fibrillation (AF) increases with age, along with comorbidities and, thus, polypharmacy. Non-adherence is associated with polypharmacy. This study aimed to identify patients at risk for cardiovascular events according to their pharmacological treatment intensity and adherence. Patients (n = 18,113) with a mean age of 71.5 +/- 8.7 years, at high cardiovascular risk were followed between December 2005 until December 2007 for a median time of 2 years. The association between polypharmacy and adherence and their impact on cardiovascular and bleeding events were explored. Adherence was defined as a study drug intake of >= 80%. Patients with more co-medications had a higher body mass index, higher prevalence of hypertension, coronary heart disease, heart failure, and diabetes mellitus (all p < 0.0001) compared to <= 4 or 5-8 co-medications, but no differences in history of stroke (p = 0.68) or transient ischemic attack (p = 0.065). Across all treatments, the adjusted hazard ratios (HRs) increased in patients with more co-medications (>= 9 vs <= 4) for all-cause death (HR 1.30; 1.06-1.59), major bleeding (HR 1.65; 1.33-2.05), and all bleeding events (HR 1.44; 1.31-1.59). Yearly event rates were higher in non-adherent than adherent patients for stroke and systemic embolism (SSE) (3.14 vs 1.00), all-cause death (7.76 vs 2.66), major bleeding (6.21 vs 2.65), and all bleeding (28.71 vs 19.05; all p < 0.0001). After an event the patients were more likely to become non-adherent (adherence after SSE 30.3%, after major bleeding 33.4%, after all bleeding 66.7%; all p < 0.0001). The treatment effects were consistent to the overall group in the different polypharmacy groups. In conclusion, polypharmacy and non-adherence are risk indicators for increased adverse cardiovascular and bleeding events. Dabigatran is safe to use across the full spectrum of AF patients, independent of the number of co-medications and adherence. Patients with co-medications and comorbidities require special attention and encouragement to adhere to oral anticoagulation. (C) 2021 Elsevier Inc. All rights reserved.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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Millenaar, Domin ...
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Schumacher, Helm ...
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Brueckmann, Mart ...
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Eikelboom, John ...
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Ezekowitz, Micha ...
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Slawik, Jonathan
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Ewen, Sebastian
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Ukena, Christian
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Wallentin, Lars, ...
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Connolly, Stuart
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Yusuf, Salim
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Bohm, Michael
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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American Journal ...
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Uppsala University