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European Heart Journal Advance Access published online on August 25, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl208
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received May 23, 2006
Revised July 14, 2006
Accepted August 10, 2006

Article

Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation

Simona Monte 1 *, Alejandro Macchia 1, Fabio Pellegrini 1, Marilena Romero 1, Vito Lepore 1, Antonio D'Ettorre 1, Mario Saugo 2, Luigi Tavazzi 3, and Gianni Tognoni 1

1 Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti 66030, Italy
2 Epidemiological Unit, ULSS 4, Alto Vicentino, Vicenza, Italy
3 Department of Cardiology, IRCCS Policlinico S. Matteo, Pavia, Italy

* To whom correspondence should be addressed.
Simona Monte, E-mail: monte{at}negrisud.it


  Abstract

Aims To assess the use of antithrombotic treatment (ATT) after hospitalization with atrial fibrillation (AF) and the attributable effectiveness of ATT during follow-up.

Methods and results On the basis of record linkage of administrative registers, 1812 patients discharged with AF were identified and followed-up for major clinical events up to 1 year. Mean age was 79 years. After hospitalization, 56% of the patients received ATT: 29% anticoagulants, 22% antiplatelets (APs), and 5% both agents. Among patients without comorbidities, 63.0% were exposed to ATT. Several factors significantly influence the use of antithrombotic agents, including increasing age [odds ratio (OR) 0.93 (95% confidence interval (CI), 0.92-0.95)], chronic obstructive pulmonary disease [0.77 (0.59-1.00)], malignancy [0.57 (0.39-0.82)], and previous use of ATT [4.56 (3.67-5.67)]. A significantly lower mortality was observed in patients exposed to ATT [hazard ratio (HR) 0.36 (95% CI, 0.28-0.47)], both to anticoagulants [0.23 (0.15-0.35)] and to APs [0.66 (0.50-0.86)]. ATT was associated with the reduction of thrombo-embolic events [0.52 (0.25-1.07)]. Major bleeding did not contribute to increased morbidity. Subgroups analysis, propensity score (PS), and sensitivity analysis confirmed these results.

Conclusion Our data demonstrated that ATT was underused, also in patients without comorbidities. Exposure to ATT is associated with improved survival among elderly high-risk community patients hospitalized with AF.

Keywords: Epidemiology; Medical record linkage; Antithrombotic treatment; Atrial fibrillation.
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