Temporal trends of time in therapeutic range and incidence of cardiovascular events in patients with non-valvular atrial fibrillation

Autor: Elio Sabbatini, Daniele Pastori, Claudia Iannilli, Tiziana Di Stefano, Francesco Violi, Mirella Saliola, Danilo Menichelli, Fabiana Albanese, Pasquale Pignatelli, Francesco Del Sole, Gregory Y.H. Lip, Domenico Ferro, Roberto Carnevale, Marco Antonio Casciaro, Patrizia Iannucci, Alessio Farcomeni
Rok vydání: 2018
Předmět:
Male
Time Factors
Vitamin K
030204 cardiovascular system & hematology
Hemorrhage/epidemiology
Stroke/epidemiology
0302 clinical medicine
Risk Factors
Atrial Fibrillation
80 and over
Vitamin K/antagonists & inhibitors
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Stroke
Aged
80 and over
biology
Incidence (epidemiology)
Incidence
Atrial fibrillation
Middle Aged
Treatment Outcome
Anticoagulants/therapeutic use
Italy
Cardiology
Female
Settore SECS-S/01 - Statistica
Italy/epidemiology
endocrine system
medicine.medical_specialty
Hemorrhage
Anticoagulation
Cardiovascular events
Time in therapeutic range
Vitamin K antagonists
Aged
Anticoagulants
Humans
Multivariate Analysis
Proportional Hazards Models
Risk Assessment
International Normalized Ratio
03 medical and health sciences
Internal medicine
Internal Medicine
medicine
Risk Assessment/methods
Survival analysis
Atrial Fibrillation/drug therapy
Proportional hazards model
business.industry
nutritional and metabolic diseases
medicine.disease
Transthyretin
biology.protein
Observational study
business
Zdroj: Pastori, D, Farcomeni, A, Saliola, M, Del Sole, F, Pignatelli, P, Violi, F, Lip, G Y H & ATHERO-AF Study Group 2018, ' Temporal trends of time in therapeutic range and incidence of cardiovascular events in patients with non-valvular atrial fibrillation ', European Journal of Internal Medicine, vol. 54, pp. 34-39 . https://doi.org/10.1016/j.ejim.2018.04.007
ISSN: 1879-0828
DOI: 10.1016/j.ejim.2018.04.007
Popis: BACKGROUND: Optimal time in therapeutic range (TTR) of vitamin K antagonists (VKAs) is crucial for cardiovascular events (CVEs) prevention in non-valvular atrial fibrillation (NVAF). The relationship between temporal changes of TTR and the incidence of CVEs has been poorly investigated. We investigated 1) temporal trends of TTR in a long-term follow-up of NVAF patients; 2) the incidence of CVEs according to changes of TTR.METHODS: Prospective observational study including 1341 NVAF outpatients (mean age 73.5 years, 42.5% male) starting VKAs. Patients were divided into 4 groups: Group 0: Optimal TTR, consistently ≥70% (n = 241); Group 1: Temporally worsening TTR, from above to below 70% (n = 263); Group 2: Temporally improving TTR, from below to above 70% (n = 270); Group 3: Suboptimal TTR, consistently RESULTS: In a mean follow-up of 37.7 months (4214.2 patient-years), 108 CVEs occurred (2.6%/year). Survival analysis showed a graded increased risk of CVEs in relation to temporal changes in TTR, with the worst outcomes in Groups 1 and 3 (log-rank test p = 0.013). Multivariable Cox proportional hazards regression analysis showed that Group 1 vs. 0 (HR: 2.096; 95%CI 1.061-4.139, p = 0.033), Group 3 vs. 0 (HR: 2.292; 95%CI 1.205-4.361, p = 0.011), CHA2DS2VASc score (HR:1.316; 95%CI 1.153-1.501, p CONCLUSION: A decrease of TTR
Databáze: OpenAIRE
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