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dc.contributor.authorHandy, Alex
dc.contributor.authorBanerjee, Amitava
dc.contributor.authorWood, Angela M
dc.contributor.authorDale, Caroline
dc.contributor.authorSudlow, Cathie LM
dc.contributor.authorTomlinson, Christopher
dc.contributor.authorBean, Daniel
dc.contributor.authorThygesen, Johan H
dc.contributor.authorMizani, Mehrdad A
dc.contributor.authorKatsoulis, Michail
dc.contributor.authorTakhar, Rohan
dc.contributor.authorHollings, Sam
dc.contributor.authorDenaxas, Spiros
dc.contributor.authorWalker, Venexia
dc.contributor.authorDobson, Richard
dc.contributor.authorSofat, Reecha
dc.contributor.authorCVD-COVID-UK Consortium
dc.date.accessioned2022-03-17T10:05:03Z
dc.date.available2022-03-17T10:05:03Z
dc.date.issued2022-05-25
dc.date.submitted2021-09-15
dc.identifier.issn1355-6037
dc.identifier.otherheartjnl-2021-320325
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/335103
dc.descriptionFunder: British Medical Association; FundRef: http://dx.doi.org/10.13039/501100000374
dc.descriptionFunder: UK Research and Innovation; FundRef: http://dx.doi.org/10.13039/100014013
dc.descriptionFunder: NIHR University College London Hospitals Biomedical Research Centre
dc.descriptionFunder: AstraZeneca; FundRef: http://dx.doi.org/10.13039/100004325
dc.descriptionFunder: NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
dc.descriptionFunder: UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare
dc.descriptionFunder: NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust
dc.description.abstractOBJECTIVE: 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.
dc.languageen
dc.publisherBMJ
dc.subjectCardiac risk factors and prevention
dc.subject1506
dc.subject2474
dc.subjectatrial fibrillation
dc.subjectCOVID-19
dc.subjectepidemiology
dc.subjectelectronic health records
dc.subjectdrug monitoring
dc.titleEvaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.
dc.typeArticle
dc.date.updated2022-03-17T10:05:03Z
prism.publicationNameHeart
dc.identifier.doi10.17863/CAM.82545
dcterms.dateAccepted2022-01-24
rioxxterms.versionofrecord10.1136/heartjnl-2021-320325
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/
rioxxterms.licenseref.startdate2022-03-07
dc.contributor.orcidHandy, Alex [0000-0002-3739-1530]
dc.contributor.orcidBanerjee, Amitava [0000-0001-8741-3411]
dc.contributor.orcidWood, Angela M [0000-0002-7937-304X]
dc.contributor.orcidSudlow, Cathie LM [0000-0002-7725-7520]
dc.contributor.orcidTomlinson, Christopher [0000-0002-0903-5395]
dc.contributor.orcidBean, Daniel [0000-0002-8594-7804]
dc.contributor.orcidThygesen, Johan H [0000-0002-7479-3459]
dc.contributor.orcidKatsoulis, Michail [0000-0002-1756-9530]
dc.contributor.orcidDenaxas, Spiros [0000-0001-9612-7791]
dc.contributor.orcidDobson, Richard [0000-0003-4224-9245]
dc.contributor.orcidSofat, Reecha [0000-0002-0242-6115]
dc.identifier.eissn1468-201X
pubs.funder-project-idMedical Research Council (MR/L003120/1)
pubs.funder-project-idBritish Heart Foundation (None)
pubs.funder-project-idBritish Heart Foundation (RG/18/13/33946)
pubs.funder-project-idNational Institute for Health Research (IS-BRC-1215-20014)
pubs.funder-project-idBritish Heart Foundation (SP/18/3/33801)
cam.issuedOnline2022-05-25
rioxxterms.freetoread.startdate2022-03-07
rioxxterms.freetoread.startdate2022-03-07


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