Association between personalized evidence-based anticoagulation therapy and outcomes at 1-year follow-up in patients with atrial fibrillation: an analysis from the Atrial Fibrillation registry. (14th October 2021)

• Record Type: Journal Article
• Authors: Pokushalov, E; Losik, D; Kozlova, S; Konradi, A; Sekacheva, M; Ponomarenko, A; Krivosheev, Y; Mikheenko, I; Kretov, E; Steinberg, J.S
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Oral Anticoagulation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0550
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: The guideline treatments based on a relatively broad set of enrollment criteria inhibits the personalized evidence-based approach. Personalized evidence-based medicine (EBM) involves the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment. Objective: We report the 1-year follow-up data of the Atrial Fibrillation Registry, focusing on the relationship between personalized EBM and guideline-adherent anticoagulation therapy use and the occurrence of major clinical adverse events. Methods: 2683 patients at high risk for stroke and 1-year follow-up were enrolled in study. The primary endpoint was the percentage of guideline-based and personalized EBM recommendations acted on by clinicians. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints. Results: From 2683 patients, 1971 (73.5%) EMR were guideline adherent and only 824 (30.7%) of them were personalized EBM anticoagulation therapy adherent, whilst 712 (26.5%) were non-guideline adherent and 1147 (42.8%) were guideline adherent but non-personalized EBM adherent. The composite endpoint of cardiovascular death, any TE or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02). The endpoint of all cause death and any TE is increased by >20% by guideline adherent but non-personalized EBM adherent treatment [hazard ratio (HR) 1.254 (95% CI 0.931; 1.689)] and >80% non-guideline adherent and non-personalized EBM adherent treatment [HR 1.892 (95% CI 1.359; 2.635)]. For the composite endpoint of cardiovascular death, any TE or bleeding, guideline adherent but non-personalized EBM adherent treatment increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)]. Conclusion: Personalized EBM anticoagulation management is associated with significantly better outcomes, including those related to the composite endpoint of cardiovascular death, any TE or bleeding in high-risk patients. Funding Acknowledgement: Type of funding sources: None.