CC-BY 4.0 · TH Open 2018; 02(01): e33-e38
DOI: 10.1055/s-0038-1626732
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Anticoagulation and Mortality Rates among Hospitalized Patients with Atrial Fibrillation

Gregory Piazza
1  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Shelley Hurwitz
2  Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Lindsay M. Harrigan
1  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Kathryn L. Jenkins
1  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Benjamin Hohlfelder
3  Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
John Fanikos
3  Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Samuel Z. Goldhaber
1  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Funding This study was funded in part by a research grant from the Bristol-Myers Squibb–Pfizer Alliance. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Further Information

Publication History

17 July 2017

19 December 2017

Publication Date:
30 January 2018 (online)

Abstract

Atrial fibrillation (AF) is associated with an increased rate of mortality, heart failure, and stroke. We conducted an observational study to assess the relationship between anticoagulation and adverse clinical outcomes in hospitalized patients with AF. We performed a 5,000-consecutive-patient retrospective cohort analysis of anticoagulation prescription and 90-day outcomes in patients with AF hospitalized at Brigham and Women's Hospital from May 2008 to September 2014. All-cause mortality at 90 days was 5.4%. The frequency of death between hospital discharge and day 90 was lower in patients who were anticoagulated at discharge (2.8 vs. 7.1%, p < 0.001). Anticoagulation prescription at discharge was associated with a 60% reduction in death between discharge and day 90, after adjustment for confounding factors. Major adverse events at day 90, including death, myocardial infarction, stroke, and major bleeding, were more frequent in patients who were not prescribed anticoagulation at discharge (16.5 vs. 10.4%, p < 0.001). In multivariable regression analysis, prescription of anticoagulation at discharge predicted a lower mortality (adjusted odds ratio (OR), 0.4; 95% confidence interval (CI), 0.3–0.53) and lower major adverse event rate (adjusted OR, 0.64; 95% CI, 0.54–0.76) by day 90. In conclusion, all-cause mortality at 90 days was high among inpatients with AF. Patients with AF who were not prescribed anticoagulation at discharge had an increased risk of death at 90 days. Hospitalization represents a special opportunity to optimize cardiovascular risk reduction strategies, including anticoagulation.

Authors' Contributions

Drs. Piazza and Hurwitz had full access to all the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Piazza (BWH, Cardiovascular Division) and Hurwitz (BWH, Center for Clinical Investigation) conducted and are responsible for the data analysis.