Oral anticoagulation across diabetic subtypes in patients with newly diagnosed atrial fibrillation: A report from the GARFIELD‐AF registry

Author:

Bassand Jean‐Pierre12ORCID,Virdone Saverio2,Camm A. John3,Fox Keith A. A.4,Goldhaber Samuel Z.5,Goto Shinya6,Haas Sylvia7,Hacke Werner8,Kayani Gloria2,Keltai Matyas9,Misselwitz Frank2,Pieper Karen S.2,Turpie Alexander G. G.10,Verheugt Freek W. A.11,Kakkar Ajay K.2,

Affiliation:

1. University of Besançon Franche‐Comté Besançon France

2. Thrombosis Research Institute London UK

3. Cardiology Clinical Academic Group Molecular & Clinical Sciences Institute St. George's University of London London UK

4. Centre for Cardiovascular Science University of Edinburgh Edinburgh UK

5. Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA

6. Tokai University School of Medicine Kanagawa Japan

7. Formerly Klinikum rechts der Isar Technical University of Munich Munich Germany

8. University of Heidelberg Heidelberg Germany

9. Hungarian Cardiovascular Institute Semmelweis University Budapest Hungary

10. McMaster University Hamilton Ontario Canada

11. Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam The Netherlands

Abstract

AbstractAimsThis study aims to describe both management and prognosis of patients with diabetes mellitus (DM) and newly diagnosed atrial fibrillation (AF), overall as well as by antidiabetic treatment, and to assess the influence of oral anticoagulation (OAC) on outcomes by DM status.MethodsThe study population comprised 52 010 newly diagnosed patients with AF, 11 542 DM and 40 468 non‐DM, enrolled in the GARFIELD‐AF registry. Follow‐up was truncated at 2 years after enrolment. Comparative effectiveness of OAC versus no OAC was assessed by DM status using a propensity score overlap weighting scheme and weights were applied to Cox models.ResultsPatients with DM [39.3% oral antidiabetic drug (OAD), 13.4% insulin ± OAD, 47.2% on no antidiabetic drug] had higher risk profile, OAC use, and rates of clinical outcomes compared with patients without DM. OAC use was associated in patients without DM and patients with DM with lower risk of all‐cause mortality [hazard ratio 0.75 (0.69‐0.83), 0.74 (0.64‐0.86), respectively] and stroke/systemic embolism (SE) [0.69 (0.58‐0.83), 0.70 (0.53‐0.93), respectively]. The risk of major bleeding with OAC was similarly increased in patients without DM and those with DM [1.40 (1.14‐1.71), 1.37 (0.99‐1.89), respectively]. Patients with insulin‐requiring DM had a higher risk of all‐cause mortality and stroke/SE [1.91 (1.63‐2.24)], [1.57 (1.06‐2.35), respectively] compared with patients without DM, and experienced significant risk reductions of all‐cause mortality and stroke/SE with OAC [0.73 (0.53‐0.99); 0.50 (0.26‐0.97), respectively].ConclusionsIn both patients with DM and patients without DM with AF, OAC was associated with lower risk of all‐cause mortality and stroke/SE. Patients with insulin‐requiring DM derived significant benefit from OAC.

Publisher

Wiley

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine

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