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Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation - a cohort study from Sweden using propensity score analyses

Wandell, Per; Carlsson, Axel C.; Sundquist, Jan LU ; Johansson, Sven-Erik LU ; Bottai, Matteo and Sundquist, Kristina LU (2014) In Diabetology and Metabolic Syndrome 6.
Abstract
Aims: To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care. Methods: Study population consisted of men (n = 1319) and women (n = 1094) aged = >= 45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age,... (More)
Aims: To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care. Methods: Study population consisted of men (n = 1319) and women (n = 1094) aged = >= 45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy). Results: Overall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients < 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged >= 80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those < 80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients < 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those >= 80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52). Conclusions: Our findings suggest that antiplatelets could exert a beneficial effect among those above 80 years. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antithrombotic drugs, Statins, Pharmacotherapy, Mortality, Follow-up
in
Diabetology and Metabolic Syndrome
volume
6
publisher
BioMed Central
external identifiers
  • wos:000329712300001
  • scopus:84892169809
ISSN
1758-5996
DOI
10.1186/1758-5996-6-2
language
English
LU publication?
yes
id
6d3e755f-2824-4ee2-bc45-20c22ab76941 (old id 4319582)
date added to LUP
2014-03-03 08:02:38
date last changed
2017-01-01 06:14:45
@article{6d3e755f-2824-4ee2-bc45-20c22ab76941,
  abstract     = {Aims: To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care. Methods: Study population consisted of men (n = 1319) and women (n = 1094) aged = &gt;= 45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy). Results: Overall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients &lt; 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged &gt;= 80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those &lt; 80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients &lt; 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those &gt;= 80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52). Conclusions: Our findings suggest that antiplatelets could exert a beneficial effect among those above 80 years.},
  articleno    = {2},
  author       = {Wandell, Per and Carlsson, Axel C. and Sundquist, Jan and Johansson, Sven-Erik and Bottai, Matteo and Sundquist, Kristina},
  issn         = {1758-5996},
  keyword      = {Antithrombotic drugs,Statins,Pharmacotherapy,Mortality,Follow-up},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Diabetology and Metabolic Syndrome},
  title        = {Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation - a cohort study from Sweden using propensity score analyses},
  url          = {http://dx.doi.org/10.1186/1758-5996-6-2},
  volume       = {6},
  year         = {2014},
}