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Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.

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cam.issuedOnline2022-05-25
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.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.date.accessioned2022-03-17T10:05:03Z
dc.date.available2022-03-17T10:05:03Z
dc.date.issued2022-05-25
dc.date.submitted2021-09-15
dc.date.updated2022-03-17T10:05:03Z
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.identifier.doi10.17863/CAM.82545
dc.identifier.eissn1468-201X
dc.identifier.issn1355-6037
dc.identifier.otherheartjnl-2021-320325
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/335103
dc.languageen
dc.language.isoeng
dc.publisherBMJ
dc.publisher.urlhttp://dx.doi.org/10.1136/heartjnl-2021-320325
dc.subjectCOVID-19
dc.subjectatrial fibrillation
dc.subjectdrug monitoring
dc.subjectelectronic health records
dc.subjectepidemiology
dc.subjectAged
dc.subjectAnticoagulants
dc.subjectAtrial Fibrillation
dc.subjectCOVID-19
dc.subjectFemale
dc.subjectFibrinolytic Agents
dc.subjectHumans
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectStroke
dc.subjectWarfarin
dc.titleEvaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.
dc.typeArticle
dcterms.dateAccepted2022-01-24
prism.publicationNameHeart
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 and Care Research (IS-BRC-1215-20014)
pubs.funder-project-idBritish Heart Foundation (SP/18/3/33801)
pubs.funder-project-idMedical Research Council (MC_PC_17214)
pubs.funder-project-idMRC (via University College London (UCL)) (MC_PC_20059)
rioxxterms.freetoread.startdate2022-03-07
rioxxterms.licenseref.startdate2022-03-07
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1136/heartjnl-2021-320325

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