Abstract 14572: Polypharmacy and Major Adverse Events in Atrial Fibrillation: Observations From the Korea National Health Insurance Service Data

Introduction: Previous evidence suggests that atrial fibrillation (AF) patients who receive polypharmacy are at an increased risk of experiencing adverse events. In this study, we investigated the prevalence of polypharmacy, identified risk factors associated with polypharmacy, and assessed the impact of polypharmacy on clinical outcomes in a ‘real-world’ data.

Methods: We included 451,368 participants without AF (54[48.0-63.0] years; 207,748[46.0%] female) in the Korea National Health Insurance Service-Health Screening (NHIS-HealS) cohort from 2002 to 2013. All concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥5 concomitant drugs. All-cause death, ischemic strokes/transient ischemic attacks (TIAs), major bleeding, heart failure admission were recorded.

Results: With up to 7.7 (6.8-8.3) years of follow-up and 768,306 person-years, 12,241 incident AF cases occurred. Among included AF patients (40.0% females, 63.0[54.0-70.0] years), the prevalence of polypharmacy was 30.9 % (3,784). In new-onset AF, older age (per 10 increases, OR 1.32, 95% CI 1.26-1.40), hypertension (OR 4.00, 95 % CI 3.62-4.43), diabetes mellitus (OR 3.25, 95 % CI 2.86-3.70), COPD (OR 3.00, 95% CI 2.51-3.57), ischemic stroke/TIA (OR 2.36, 95% CI 2.03-2.73), dementia (OR 2.30, 95% CI 1.06-4.98), ESRD or CKD (OR 1.97, 95% CI 1.38-2.82), and heart failure (OR 1.95, 95% CI 1.69-2.26) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence and risk of major bleeding (aHR 1.26, 95% CI 1.12-1.41). All-cause mortality showed higher incidence, the risk was higher but not statistically significant (aHR 1.11, 95 % CI 0.99-1.24). The risks of stroke and heart failure admission were not changed by polypharmacy.

Conclusions: In this “real world” nationwide AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with major bleeding events.