Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.
Authors
Dale, Caroline
Mizani, Mehrdad A
Takhar, Rohan
Hollings, Sam
Walker, Venexia
CVD-COVID-UK Consortium
Publication Date
2022-05-25Journal Title
Heart
ISSN
1355-6037
Publisher
BMJ
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Handy, A., Banerjee, A., Wood, A. M., Dale, C., Sudlow, C. L., Tomlinson, C., Bean, D., et al. (2022). Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.. Heart https://doi.org/10.1136/heartjnl-2021-320325
Description
Funder: British Medical Association; FundRef: http://dx.doi.org/10.13039/501100000374
Funder: UK Research and Innovation; FundRef: http://dx.doi.org/10.13039/100014013
Funder: NIHR University College London Hospitals Biomedical Research Centre
Funder: AstraZeneca; FundRef: http://dx.doi.org/10.13039/100004325
Funder: NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
Funder: UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare
Funder: NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust
Abstract
OBJECTIVE: To evaluate antithrombotic (AT) use in individuals with atrial fibrillation (AF) and at high risk of stroke (CHA2DS2-VASc score ≥2) and investigate whether pre-existing AT use may improve COVID-19 outcomes. METHODS: Individuals with AF and CHA2DS2-VASc score ≥2 on 1 January 2020 were identified using electronic health records for 56 million people in England and were followed up until 1 May 2021. Factors associated with pre-existing AT use were analysed using logistic regression. Differences in COVID-19-related hospitalisation and death were analysed using logistic and Cox regression in individuals with pre-existing AT use versus no AT use, anticoagulants (AC) versus antiplatelets (AP), and direct oral anticoagulants (DOACs) versus warfarin. RESULTS: From 972 971 individuals with AF (age 79 (±9.3), female 46.2%) and CHA2DS2-VASc score ≥2, 88.0% (n=856 336) had pre-existing AT use, 3.8% (n=37 418) had a COVID-19 hospitalisation and 2.2% (n=21 116) died, followed up to 1 May 2021. Factors associated with no AT use included comorbidities that may contraindicate AT use (liver disease and history of falls) and demographics (socioeconomic status and ethnicity). Pre-existing AT use was associated with lower odds of death (OR=0.92, 95% CI 0.87 to 0.96), but higher odds of hospitalisation (OR=1.20, 95% CI 1.15 to 1.26). AC versus AP was associated with lower odds of death (OR=0.93, 95% CI 0.87 to 0.98) and higher hospitalisation (OR=1.17, 95% CI 1.11 to 1.24). For DOACs versus warfarin, lower odds were observed for hospitalisation (OR=0.86, 95% CI 0.82 to 0.89) but not for death (OR=1.00, 95% CI 0.95 to 1.05). CONCLUSIONS: Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF.
Keywords
Cardiac risk factors and prevention, 1506, 2474, atrial fibrillation, COVID-19, epidemiology, electronic health records, drug monitoring
Sponsorship
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
British Heart Foundation (RG/18/13/33946)
National Institute for Health Research (IS-BRC-1215-20014)
British Heart Foundation (SP/18/3/33801)
Identifiers
heartjnl-2021-320325
External DOI: https://doi.org/10.1136/heartjnl-2021-320325
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335103
Rights
Licence:
http://creativecommons.org/licenses/by-nc/4.0/
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