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 <70% (n = 567). 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), CHA 2 DS 2 VASc score (HR:1.316; 95%CI 1.153–1.501, p < 0.001) and PPIs (HR:0.453; 95%CI 0.285–0.721, p = 0.001) were independently associated with CVEs. Conclusion: A decrease of TTR <70% over time is observed in almost 20% of NVAF patients. Patients with worsening TTR temporally (ie. from initially above 70% to below 70%) have similar risk of CVEs of patients with consistently suboptimal anticoagulation.
Pastori, D., Farcomeni, A., Saliola, M., Del Sole, F., Pignatelli, P., Violi, F., et al. (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, 54, 34-39 [10.1016/j.ejim.2018.04.007].
Temporal trends of time in therapeutic range and incidence of cardiovascular events in patients with non-valvular atrial fibrillation
Farcomeni A.;
2018-01-01
Abstract
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 <70% (n = 567). 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), CHA 2 DS 2 VASc score (HR:1.316; 95%CI 1.153–1.501, p < 0.001) and PPIs (HR:0.453; 95%CI 0.285–0.721, p = 0.001) were independently associated with CVEs. Conclusion: A decrease of TTR <70% over time is observed in almost 20% of NVAF patients. Patients with worsening TTR temporally (ie. from initially above 70% to below 70%) have similar risk of CVEs of patients with consistently suboptimal anticoagulation.File | Dimensione | Formato | |
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