Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study
Objectives To examine the effect of pre-existing atrial fibrillation (AF) and associated therapy on the risk of arterial thromboembolism (ATE) and death following pneumonia.Design, setting and participants Population-based cohort study (1997–2012) of 88 315 patients with first-time hospitalisation w...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2014-11-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/4/11/e006486.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823864520106311680 |
|---|---|
| author | Reimar Wernich Thomsen Christian Fynbo Christiansen Bodil Steen Rasmussen Lars Hvilsted Rasmussen Jacob Gamst |
| author_facet | Reimar Wernich Thomsen Christian Fynbo Christiansen Bodil Steen Rasmussen Lars Hvilsted Rasmussen Jacob Gamst |
| author_sort | Reimar Wernich Thomsen |
| collection | DOAJ |
| description | Objectives To examine the effect of pre-existing atrial fibrillation (AF) and associated therapy on the risk of arterial thromboembolism (ATE) and death following pneumonia.Design, setting and participants Population-based cohort study (1997–2012) of 88 315 patients with first-time hospitalisation with pneumonia in Northern Denmark.Results Of the included patients (median age 73.4 years), 8880 (10.1%) had pre-existing AF. The risk of ATE within 30 days of admission was 5.2% in patients with AF and 3.6% in patients without AF. After adjustment for higher age and comorbidity, the adjusted HR (aHR) with AF was 1.06 (95% CI 0.96 to 1.18). Among patients with AF, reduced risk of ATE was observed in vitamin-K antagonist users compared with non-users (aHR 0.74 (95% CI 0.61 to 0.91)). Thirty-day mortality was 20.1% in patients with AF and 13.9% in patients without AF. Corresponding 1-year mortalities were 43.7% and 30.3%. The aHRs for 30-day and 1-year mortality with AF were 1.00 (95% CI 0.94 to 1.05) and 1.01 (95% CI 0.98 to 1.05). In patients with AF, reduced mortality risk was observed in users of vitamin-K antagonists (aHR 0.70 (95% CI 0.63 to 0.77)) and β-blockers (aHR 0.77 (95% CI 0.70 to 0.85). Increased mortality was found in digoxin users (aHR 1.16 (95% CI 1.06 to 1.28)).Conclusions Pre-existing AF is frequent in patients hospitalised with pneumonia and a marker of increased risk of ATE and death, explained by higher patient age and comorbidity. Prognosis is closely related to preadmission medical treatment for AF. |
| format | Article |
| id | doaj-art-dff289a254be4fbaacd6e8c3e5cb19b9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2014-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-dff289a254be4fbaacd6e8c3e5cb19b92025-02-08T23:05:11ZengBMJ Publishing GroupBMJ Open2044-60552014-11-0141110.1136/bmjopen-2014-006486Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort studyReimar Wernich Thomsen0Christian Fynbo Christiansen1Bodil Steen Rasmussen2Lars Hvilsted Rasmussen3Jacob Gamst41 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark7 Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, DenmarkDepartment of Cardiology, Aalborg University Hospital, Aalborg, DenmarkDepartment of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aalborg, DenmarkObjectives To examine the effect of pre-existing atrial fibrillation (AF) and associated therapy on the risk of arterial thromboembolism (ATE) and death following pneumonia.Design, setting and participants Population-based cohort study (1997–2012) of 88 315 patients with first-time hospitalisation with pneumonia in Northern Denmark.Results Of the included patients (median age 73.4 years), 8880 (10.1%) had pre-existing AF. The risk of ATE within 30 days of admission was 5.2% in patients with AF and 3.6% in patients without AF. After adjustment for higher age and comorbidity, the adjusted HR (aHR) with AF was 1.06 (95% CI 0.96 to 1.18). Among patients with AF, reduced risk of ATE was observed in vitamin-K antagonist users compared with non-users (aHR 0.74 (95% CI 0.61 to 0.91)). Thirty-day mortality was 20.1% in patients with AF and 13.9% in patients without AF. Corresponding 1-year mortalities were 43.7% and 30.3%. The aHRs for 30-day and 1-year mortality with AF were 1.00 (95% CI 0.94 to 1.05) and 1.01 (95% CI 0.98 to 1.05). In patients with AF, reduced mortality risk was observed in users of vitamin-K antagonists (aHR 0.70 (95% CI 0.63 to 0.77)) and β-blockers (aHR 0.77 (95% CI 0.70 to 0.85). Increased mortality was found in digoxin users (aHR 1.16 (95% CI 1.06 to 1.28)).Conclusions Pre-existing AF is frequent in patients hospitalised with pneumonia and a marker of increased risk of ATE and death, explained by higher patient age and comorbidity. Prognosis is closely related to preadmission medical treatment for AF.https://bmjopen.bmj.com/content/4/11/e006486.full |
| spellingShingle | Reimar Wernich Thomsen Christian Fynbo Christiansen Bodil Steen Rasmussen Lars Hvilsted Rasmussen Jacob Gamst Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study BMJ Open |
| title | Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study |
| title_full | Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study |
| title_fullStr | Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study |
| title_full_unstemmed | Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study |
| title_short | Pre-existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia: a population-based cohort study |
| title_sort | pre existing atrial fibrillation and risk of arterial thromboembolism and death following pneumonia a population based cohort study |
| url | https://bmjopen.bmj.com/content/4/11/e006486.full |
| work_keys_str_mv | AT reimarwernichthomsen preexistingatrialfibrillationandriskofarterialthromboembolismanddeathfollowingpneumoniaapopulationbasedcohortstudy AT christianfynbochristiansen preexistingatrialfibrillationandriskofarterialthromboembolismanddeathfollowingpneumoniaapopulationbasedcohortstudy AT bodilsteenrasmussen preexistingatrialfibrillationandriskofarterialthromboembolismanddeathfollowingpneumoniaapopulationbasedcohortstudy AT larshvilstedrasmussen preexistingatrialfibrillationandriskofarterialthromboembolismanddeathfollowingpneumoniaapopulationbasedcohortstudy AT jacobgamst preexistingatrialfibrillationandriskofarterialthromboembolismanddeathfollowingpneumoniaapopulationbasedcohortstudy |