Effect of cardiovascular drugs on mortality in atrial fibrillation and chronic heart failure

Figures & data

Table I. Data for patients aged 45 years or above with diagnoses of AF and concomitant chronic heart failure (n = 2,314) in primary care attending the 75 PHCCs between January 1st 2001 and December 31st 2007.

	Men		Women		Sex difference
	All n (%)	Died n (%)	All n (%)	Died n (%)	All p	Died p
Number of patients	1,159	214 (18.5)	1,155	241 (20.9)		0.15
Age (years), mean (SD)	75.9 (9.2)		79.7 (7.9)		< 0.001
Age groups (years),					< 0.001
45–54	29 (2.5)	2 (6.9)	6 (0.5)	0 (0.0)		1.00
55–64	116 (10.0)	7 (6.0)	46 (4.0)	2 (4.4)		1.00
65–74	297 (25.6)	23 (7.7)	203 (17.6)	18 (8.9)		0.65
75–79	262 (22.6)	49 (18.7)	248 (21.5)	42 (16.9)		0.60
80–84	266 (23.0)	59 (22.2)	335 (29.0)	66 (19.7)		0.46
≥ 85	189 (16.3)	74 (39.2)	317 (27.5)	113 (35.7)		0.43
Educational level					< 0.001
Compulsory schooling	481 (45.5)	80 (16.6)	555 (58.4)	96 (17.3)		0.78
Secondary schooling	371 (35.1)	65 (17.5)	285 (30.0)	41 (14.4)		0.28
College and/or university studies	206 (19.5)	21 (10.2)	117 (11.7)	13 (11.7)		0.68
Marital status					< 0.001
Married	609 (52.8)	112 (18.4)	265 (23.1)	42 (15.9)		0.37
Unmarried	117 (10.2)	16 (13.7)	78 (7.7)	15 (19.2)		0.30
Divorced	172 (14.9)	24 (14.0)	146 (12.7)	20 (13.7)		0.95
Widowed	255 (22.1)	58 (22.8)	659 (57.4)	158 (24.0)		0.69
Diagnosis
Hypertension	403 (34.8)	49 (12.1)	491 (42.5)	81 (16.5)	< 0.001	0.07
CHD	300 (25.9)	54 (18.0)	297 (25.7)	59 (19.9)	0.93	0.56
Diabetes mellitus	228 (19.7)	38 (16.7)	250 (21.7)	46 (18.4)	0.24	0.62
Valvular disease	87 (7.5)	13 (14.9)	99 (8.6)	20 (20.2)	0.35	0.35
Cardiomyopathy	24 (2.1)	2 (8.3)	11 (1.0)	0 (0.0)	0.03	1.00
CVDs	126 (10.9)	27 (21.4)	131 (11.3)	41 (31.3)	0.72	0.07
Cerebral bleedings	8 (0.8)	2 (25.0)	2 (0.2)	1 (50.0)	0.06	1.0

Information on educational level and marital status is missing for some individuals.

Table II. Prescription data for patients aged 45 years or above with diagnoses of AF and concomitant chronic heart failure (n = 2,314) in primary care attending the 75 PHCCs between January 1st 2001 and December 31st 2007.

	Men (n = 1,159) n (%)	Women (n = 1,155) n (%)	Sex difference
			Crude	Age-adjusted
			p	p
All antithrombotic agents (B01A)	1,047 (90.3)	1,026 (88.8)	0.24	0.53
Anticoagulant agents (B01AA)	692 (59.7)	658 (48.3)	< 0.001	0.89
Antiplatelet agents (B01AC)	663 (57.2)	740 (64.1)	0.001	0.09
ASA (B01AC6, B01AC30)	643 (55.5)	715 (61.9)	0.002	0.13
Digitalis (C01A)	535 (46.2)	677 (58.6)	< 0.001	< 0.001
Specific anti-arrhythmic agents (C01B)	27 (2.3)	16 (1.4)	0.09	0.08
Any diuretic treatment (C03)	993 (85.7)	1,058 (91.6)	< 0.001	< 0.001
Loop diuretics (C03C)	946 (81.6)	1,000 (86.6)	0.001	0.02
Thiazides (C03A, C03B, C03E, C09B C09DA)	175 (15.1)	265 (22.9)	< 0.001	< 0.001
Any potassium-saving agent (C03D)	414 (35.7)	522 (45.2)	< 0.001	< 0.001
Aldosterone antagonists (C03DA)	323 (27.9)	370 (32.0)	0.03	0.01
All beta blockers (C07)	810 (69.9)	839 (72.6)	0.44	0.001
Beta1-selective agents (C07AB, C07F)	726 (62.6)	779 (67.5)	0.02	< 0.001
Non-selective beta blockers (C07AA)	191 (16.5)	171 (14.8)	0.27	0.85
RAS-blocking agents (C09)	854 (73.7)	730 (63.2)	< 0.001	< 0.001
ACE inhibitors (C09A, C09B)	721 (62.2)	598 (51.8)	< 0.001	< 0.001
ARB (C09C, C09D)	253 (21.8)	265 (22.9)	0.52	0.10
Calcium channel blockers (C08)	295 (25.5)	312 (27.0)	0.39	0.24
Heart active (C08D)	94 (8.1)	116 (10.0)	0.11	0.05
Vessel selective (C08C, C09DB)	214 (18.5)	218 (18.9)	0.80	0.58
All lipid-lowering drugs (C10A)	317 (27.4)	265 (22.9)	0.02	0.90
Statins (C10AA)	313 (27.1)	251 (21.7)	0.003	0.59

Table III. Cox regression models for patients (n = 2,314) aged 45–104 years with AF and concomitant chronic heart failure attending the 75 PHCCs between January 1st 2001 and December 31st 2007, stratified by age.

Sample size	Patients aged < 80 years Full model HR (95% CI) n = 1,207	Patients aged ≥ 80 years Full model HR (95% CI) n = 1,107	All patients Full model HR (95% CI) n = 2,314
Antithrombotic drugs
Antiplatelets vs. no treatment	0.94 (0.50–1.74)	0.89 (0.54–1.50)	0.95 (0.64–1.40)
Anticoagulants vs. no treatment	0.34 (0.18–0.64)	0.73 (0.43–1.23)	0.53 (0.35–0.81)
Anticoagulants vs. antiplatelets	0.42 (0.28–0.62)	0.92 (0.66–1.28)	0.65 (0.50–0.84)
Digitalis	1.35 (0.94–1.96)	0.84 (0.61–1.14)	1.05 (0.83–1.33)
Thiazides	1.00 (0.61–1.62)	0.82 (0.53–1.27)	0.89 (0.65–1.23)
Loop diuretics	1.14 (0.66–1.94)	0.71 (0.45–1.11)	0.92 (0.66–1.29)
Aldosterone antagonists	1.17 (0.80–1.72)	1.15 (0.83–1.59)	1.21 (0.94–1.55)
Beta blockers	0.95 (0.63–1.44)	0.74 (0.53–1.03)	0.81 (0.62–1.04)
RAS-blocking agents	0.77 (0.49–1.21)	0.80 (0.58–1.11)	0.82 (0.63–1.05)
Calcium channel blockers	0.77 (0.49–1.21)	0.66 (0.44–0.98)	0.70 (0.52–0.94)
Statins	0.60 (0.38–0.95)	0.62 (0.35–1.10)	0.62 (0.43–0.88)

Full Model is multivariate and is adjusted for a propensity score comprising sex, age group, co-morbidities, educational level, marital status and all noted pharmacotherapies. HRs and 95% CIs are shown. Statistically significant HRs are highlighted in bold.

Table IV. Laplace regression with years to first 10% mortality models for patients (n = 2,314) aged 45–104 years with AF and concomitant chronic heart failure attending the 75 PHCCs between January 1st 2001 and December 31st 2007, stratified by age.

Sample size	Patients aged < 80 years Full model Years (95% CI) n = 1,207	Patients aged ≥ 80 years Full model Years (95% CI) n = 1,107	All patients Full model Years (95% CI) n = 2,314
Antithrombotic drugs
Antiplatelets vs. no treatment	0.99 (− 1.07; 3.05)	− 0.12 (− 1.15; 0.90)	0.09 (− 0.88; 1.06)
Anticoagulants vs. no treatment	4.02 (2.49; 5.55)	− 0.22 (− 2.80; 2.35)	1.95 (0.47; 3.43)
Anticoagulants vs. antiplatelets	2.60 (1.71; 3.48)	0.30 (− 0.96; 1.56)	1.26 (0.42; 2.10)
Digitalis	− 0.36 (− 1.43; 0.70)	0.71 (− 0.59; 2.02)	0.25 (− 0.69; 1.19)
Thiazides	0.72 (− 1.89; 3.34)	0.38 (− 1.20; 1.96)	0.81 (− 0.20; 1.81)
Loop diuretics	− 1.17 (− 3.68; 1.34)	0.48 (− 0.41; 1.38)	0.08 (− 0.89; 1.04)
Aldosterone antagonists	0.05 (− 0.97; 1.07)	− 0.04 (− 1.67; 1.59)	0.06 (− 0.72; 0.83)
Beta blockers	0.94 (− 0.10; 1.99)	0.54 (− 0.54; 1.62)	0.90 (− 0.01; 1.81)
RAS-blocking agents	0.90 (− 0.13; 1.92)	0.63 (− 0.09; 1.35)	0.77 (0.12; 1.42)
Calcium channel blockers	1.17 (− 0.28; 2.62)	0.91 (− 0.12; 1.95)	1.17 (0.21; 2.14)
Statins	1.60 (0.46; 2.74)	1.03 (0.19; 1.86)	1.49 (0.39; 2.59)

Full Model is multivariate and is adjusted for a propensity score comprising sex, age group, co-morbidities, educational level, marital status and all pharmacotherapies. Years to first 10% mortality and 95% CIs are shown. Statistically significant results are highlighted in bold.