Relationship of adverse events to quality of anticoagulation control in atrial fibrillation patients with diabetes: real-world data from the FANTASIIA Registry

Abstract

Background: Atrial fibrillation (AF) patients with diabetes (DM) have high risk of cardiovascular events. Purpose: To compare clinical characteristics, adverse outcomes and quality of anticoagulation in AF patients regarding DM status. Methods: AF patients from FANTASIIA registry were included. Baseline characteristics and comorbidities were recorded. After 2-years follow-up, the association between adverse events and DM was evaluated. Results: 1956 patients (mean age 73.8 ± 9.5 years, 56% male) were analyzed; 574 (29.3%) had DM. Diabetic patients had also high prevalence of hypertension (90.6% vs 76.1%; p < .001) or renal disease (21.4% vs 15.9%; p < .001). After median follow-up of 1077 days (IQR 766-1113 days), diabetic patients had high total mortality (16.9%/year vs 11.4%/year; p < .001), cardiovascular mortality (9.1%/year vs 3.9%/year; p < .001) and MACE (12.9%/year vs 6.8%/year; p < .001). DM patients had poor anticoagulation control (time in therapeutic range: 58.52 ± 24.37% vs 62.68 ± 25.31%; p ¼ .002). DM with lower TTR showed higher cardiovascular death and MACE. Multivariate analysis showed an independent association between DM and cardiovascular mortality [HR 1.73 (IC95% 1.07-2.80); p ¼ .024]. Conclusion: AF Diabetic patients have higher comorbidities and poorer TTR than nondiabetic patients. Low TTR was associated with adverse events. The risk of cardiovascular outcomes was higher in DM patients, with independent association between DM and mortality risk.

Impact of preexisting diabetes mellitus on cardiovascular and all-cause mortality in patients with atrial fibrillation: A meta-analysis

“…The precise mechanisms underlying the impact of diabetes mellitus on survival in atrial fibrillation patients are not fully elucidated. First, atrial fibrillation patients with diabetes had more concomitant risk factors and comorbidities ( 17 , 25 ). Second, atrial fibrillation patients with diabetes had a significant reduction in the quality of anticoagulation control ( 25 ).…”

“…First, atrial fibrillation patients with diabetes had more concomitant risk factors and comorbidities ( 17 , 25 ). Second, atrial fibrillation patients with diabetes had a significant reduction in the quality of anticoagulation control ( 25 ). Third, diabetes could also cause structural, electrical, electromechanical, and autonomic remodeling ( 37 ), which could be responsible for atrial fibrillation recurrence.…”

Impact of diabetes on the management and outcomes in atrial fibrillation: an analysis from the ESC-EHRA EORP-AF Long-Term General Registry

“…Vitamin K antagonist was more frequently prescribed in patients with diabetes; this was likely related to the severity of renal impairment in this group rather than the presence of diabetes per se, as both non-vitamin K antagonist oral anticoagulants and vitamin K antagonist have been shown to be effective amongst these patients. Of note, a recent study showed that patients with diabetes had poorer time-in-therapeutic range (TTR) than patients without diabetes, and that lower TTR was associated with a higher risk of adverse events [18]. This highlights the need for closer monitoring in patients with diabetes.…”

Factor Xa inhibitors versus warfarin in patients with non-valvular atrial fibrillation and diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

“…For the prevention of stroke in patients with NVAF, the 2018 European Heart Rhythm Association Room Fibrillation anticoagulation guidelines recommend NOACs as the treatment of choice 20 . As indicated by prior research, patients with NVAF and diabetes may find it more difficult and less compliant to adhere to anticoagulation standards while taking warfarin; therefore, NOACs are a preferable option for this population 19 , 21 , 22 .…”