Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index

Predicting survival in atrial fibrillation (AF) patients with comorbidities is challenging. This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. We analyzed 451,368 participants from the Korea National Health Insurance Ser...

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Published in:International journal of cardiology 2024-03, Vol.398, p.131605-131605, Article 131605
Main Authors: Jung, Moonki, Yang, Pil-Sung, Kim, Daehoon, Sung, Jung-Hoon, Jang, Eunsun, Yu, Hee Tae, Kim, Tae-Hoon, Uhm, Jae-Sun, Pak, Hui-Nam, Lee, Moon-Hyoung, Joung, Boyoung
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Language:English
Subjects:
Anticoagulants - therapeutic use
Anticoagulation
Atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Charlson Comorbidity Index
Comorbidity
Hemorrhage - chemically induced
Hemorrhage - diagnosis
Hemorrhage - epidemiology
Humans
Multimorbidity
Risk Factors
Stroke - diagnosis
Stroke - epidemiology
Stroke - prevention & control
Treatment Outcome
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cited_by cdi_FETCH-LOGICAL-c362t-885268ecf8a304cbe345979c8cf87b9444eae6de2a1c17f602942046c58df9443
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container_title International journal of cardiology
container_volume 398
creator Jung, Moonki
Yang, Pil-Sung
Kim, Daehoon
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Uhm, Jae-Sun
Pak, Hui-Nam
Lee, Moon-Hyoung
Joung, Boyoung
description Predicting survival in atrial fibrillation (AF) patients with comorbidities is challenging. This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002−2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years. In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02–1.08, P 
doi_str_mv 10.1016/j.ijcard.2023.131605
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This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002−2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years. In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02–1.08, P &lt; .001). However, anticoagulants were significantly less prescribed in patients with high CCI (OR 0.97, 95%CI 0.95–0.99, P = .012). Incidence of adverse events (all-cause death, stroke, major bleeding, HF hospitalization) progressively increased in this order: low CCI without AF, high CCI without AF, low CCI with AF, and high CCI with AF (all P &lt; .001). Furthermore, high CCI with AF had a significantly higher risk compared to low CCI without AF (all-cause death, adjusted hazard ratio [aHR] 2.52, 95% CI 2.37–2.68, P &lt; .001; stroke, aHR 1.43, 95% CI 1.29–1.58, P &lt; .001; major bleeding, aHR 1.14, 95% CI 1.04–1.26, P = .007; HF hospitalization, aHR 4.75, 95% CI 4.03–5.59, P &lt; .001). High CCI predicted increased antiplatelet use and reduced oral anticoagulant prescription. AF was associated with higher risks of all-cause death, stroke, major bleeding, and HF hospitalization compared to high CCI. •Atrial fibrillation (AF) profoundly impacts morbidity and mortality.•Charlson Comorbidity Index (CCI) applied to assess AF patients' risk.•Higher CCI associated with increased antiplatelet use and reduced oral anticoagulants.•AF independently correlates more strongly with mortality, stroke, bleeding, and heart failure.•Recognizing comorbidity impact is vital for tailored treatment in AF patients.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2023.131605</identifier><identifier>PMID: 38000669</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Anticoagulants - therapeutic use ; Anticoagulation ; Atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Charlson Comorbidity Index ; Comorbidity ; Hemorrhage - chemically induced ; Hemorrhage - diagnosis ; Hemorrhage - epidemiology ; Humans ; Multimorbidity ; Risk Factors ; Stroke - diagnosis ; Stroke - epidemiology ; Stroke - prevention &amp; control ; Treatment Outcome</subject><ispartof>International journal of cardiology, 2024-03, Vol.398, p.131605-131605, Article 131605</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-885268ecf8a304cbe345979c8cf87b9444eae6de2a1c17f602942046c58df9443</citedby><cites>FETCH-LOGICAL-c362t-885268ecf8a304cbe345979c8cf87b9444eae6de2a1c17f602942046c58df9443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38000669$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jung, Moonki</creatorcontrib><creatorcontrib>Yang, Pil-Sung</creatorcontrib><creatorcontrib>Kim, Daehoon</creatorcontrib><creatorcontrib>Sung, Jung-Hoon</creatorcontrib><creatorcontrib>Jang, Eunsun</creatorcontrib><creatorcontrib>Yu, Hee Tae</creatorcontrib><creatorcontrib>Kim, Tae-Hoon</creatorcontrib><creatorcontrib>Uhm, Jae-Sun</creatorcontrib><creatorcontrib>Pak, Hui-Nam</creatorcontrib><creatorcontrib>Lee, Moon-Hyoung</creatorcontrib><creatorcontrib>Joung, Boyoung</creatorcontrib><title>Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Predicting survival in atrial fibrillation (AF) patients with comorbidities is challenging. This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002−2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years. In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02–1.08, P &lt; .001). However, anticoagulants were significantly less prescribed in patients with high CCI (OR 0.97, 95%CI 0.95–0.99, P = .012). Incidence of adverse events (all-cause death, stroke, major bleeding, HF hospitalization) progressively increased in this order: low CCI without AF, high CCI without AF, low CCI with AF, and high CCI with AF (all P &lt; .001). Furthermore, high CCI with AF had a significantly higher risk compared to low CCI without AF (all-cause death, adjusted hazard ratio [aHR] 2.52, 95% CI 2.37–2.68, P &lt; .001; stroke, aHR 1.43, 95% CI 1.29–1.58, P &lt; .001; major bleeding, aHR 1.14, 95% CI 1.04–1.26, P = .007; HF hospitalization, aHR 4.75, 95% CI 4.03–5.59, P &lt; .001). High CCI predicted increased antiplatelet use and reduced oral anticoagulant prescription. 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This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002−2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years. In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02–1.08, P &lt; .001). However, anticoagulants were significantly less prescribed in patients with high CCI (OR 0.97, 95%CI 0.95–0.99, P = .012). Incidence of adverse events (all-cause death, stroke, major bleeding, HF hospitalization) progressively increased in this order: low CCI without AF, high CCI without AF, low CCI with AF, and high CCI with AF (all P &lt; .001). Furthermore, high CCI with AF had a significantly higher risk compared to low CCI without AF (all-cause death, adjusted hazard ratio [aHR] 2.52, 95% CI 2.37–2.68, P &lt; .001; stroke, aHR 1.43, 95% CI 1.29–1.58, P &lt; .001; major bleeding, aHR 1.14, 95% CI 1.04–1.26, P = .007; HF hospitalization, aHR 4.75, 95% CI 4.03–5.59, P &lt; .001). High CCI predicted increased antiplatelet use and reduced oral anticoagulant prescription. AF was associated with higher risks of all-cause death, stroke, major bleeding, and HF hospitalization compared to high CCI. •Atrial fibrillation (AF) profoundly impacts morbidity and mortality.•Charlson Comorbidity Index (CCI) applied to assess AF patients' risk.•Higher CCI associated with increased antiplatelet use and reduced oral anticoagulants.•AF independently correlates more strongly with mortality, stroke, bleeding, and heart failure.•Recognizing comorbidity impact is vital for tailored treatment in AF patients.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38000669</pmid><doi>10.1016/j.ijcard.2023.131605</doi><tpages>1</tpages></addata></record>
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subjects Anticoagulants - therapeutic use
Anticoagulation
Atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Charlson Comorbidity Index
Comorbidity
Hemorrhage - chemically induced
Hemorrhage - diagnosis
Hemorrhage - epidemiology
Humans
Multimorbidity
Risk Factors
Stroke - diagnosis
Stroke - epidemiology
Stroke - prevention & control
Treatment Outcome
title Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index
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