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Outcomes of apixaba...
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Alexander, Karen P
(author)
Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity : Insights from the ARISTOTLE trial
- Article/chapterEnglish2019
Publisher, publication year, extent ...
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Elsevier BV,2019
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-374972
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-374972URI
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https://doi.org/10.1016/j.ahj.2018.09.017DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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BACKGROUND: Patients with atrial fibrillation (AF) often have multi-morbidity, defined as ≥3 comorbid conditions. Multi-morbidity is associated with polypharmacy, adverse events, and frailty potentially altering response to anticoagulation. We sought to describe the prevalence of multi-morbidity among older patients with AF and determine the association between multi-morbidity, clinical outcomes, and the efficacy and safety of apixaban compared with warfarin.METHODS: In this post-hoc subgroup analysis of the ARISTOTLE trial, we studied enrolled patients age ≥ 55 years (n = 16,800). Patients were categorized by the number of comorbid conditions at baseline: no multi-morbidity (0-2 comorbid conditions), moderate multi-morbidity (3-5 comorbid conditions), and high multi-morbidity (≥6 comorbid conditions). Association between multi-morbidity and clinical outcomes were analyzed by treatment with a median follow-up of 1.8 (1.3-2.3) years.RESULTS: Multi-morbidity was present in 64% (n = 10,713) of patients; 51% (n = 8491) had moderate multi-morbidity, 13% (n = 2222) had high multi-morbidity, and 36% (n = 6087) had no multi-morbidity. Compared with the no multi-morbidity group, the high multi-morbidity group was older (74 vs 69 years), took twice as many medications (10 vs 5), and had higher CHA2DS2-VASc scores (4.9 vs 2.7) (all P < .001). Adjusted rates per 100 patient-years for stroke/systemic embolism, death, and major bleeding increased with multi-morbidity (Reference no multi-morbidity; moderate multi-morbidity 1.42 [1.24-1.64] and high multi-morbidity 1.92 [1.59-2.31]), with no interaction in relation to efficacy or safety of apixaban.CONCLUSIONS: Multi-morbidity is prevalent among the population with AF; efficacy and safety of apixaban is preserved in this subgroup supporting extension of trial results to the most complex AF patients.
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Brouwer, Marc A
(author)
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Mulder, Hillary
(author)
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Vinereanu, Dragos
(author)
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Lopes, Renato D
(author)
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Proietti, Marco
(author)
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Al-Khatib, Sana M
(author)
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Hijazi, ZiadUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)ziahi940
(author)
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Halvorsen, Sigrun
(author)
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Hylek, Elaine M
(author)
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Verheugt, Freek W A
(author)
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Alexander, John H
(author)
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Wallentin, Lars,1943-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,UCR(Swepub:uu)larswall
(author)
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Granger, Christopher B
(author)
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Uppsala universitetUppsala kliniska forskningscentrum (UCR)
(creator_code:org_t)
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In:American Heart Journal: Elsevier BV208, s. 123-1310002-87031097-6744
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Alexander, Karen ...
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Brouwer, Marc A
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Mulder, Hillary
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Vinereanu, Drago ...
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Lopes, Renato D
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Proietti, Marco
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Al-Khatib, Sana ...
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Hijazi, Ziad
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Halvorsen, Sigru ...
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Hylek, Elaine M
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Verheugt, Freek ...
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Alexander, John ...
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Wallentin, Lars, ...
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Granger, Christo ...
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- MEDICAL AND HEALTH SCIENCES
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American Heart J ...
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Uppsala University