Abstract 18758: Cardiovascular Hospitalizations and Treatment Strategies in Atrial Fibrillation: Impact of Concomitant Thyroid Disease
Background: The impact of non-cardiac comorbidities on clinical outcomes, especially cardiovascular hospitalizations(CVH), that contribute to health care costs in atrial fibrillation, have not been widely studied
Methods: We examined CVH and mortality to compare clinical outcomes with amiodarone as primary therapy (Amio) to either other rhythm therapy (OR) or rate control (Rate) in patients with concomitant thyroid disease (TD) in the AFFIRM trial.
Results: Amio pts (n=735) were compared to OR (n=1298) & Rate (n=2027) cohorts. 56 pts (7.9%) with Amio,114 pts (9.2%) with OR & 178 pts (9.2%) with Rate had TD identified (p=.56). TD as defined had no impact on mortality in any group. However, among patients with TD, there was a significant increase in initial CVH events in Amio and OR pts compared to Rate (Figure, p for pairwise comparisons <.001) & with Amio compared to OR (p <.05) but no difference in length of hospital stay and acuity of care. Thyroid replacement was more frequent (15.1%) among those given Amio, compared to OR (8.5%) or Rate (4.1%). TD pts were more likely to discontinue Amio than those without TD (Fig, p=.03). Among patients with TD, after adjusting for imbalanced baseline covariates, treatment was still a significant predictor of CVH & mortality maintaining increased Amio related risk (Hazard ratio = 2.4, Amio vs Rate, p<.0001),and OR risk (Hazard Ratio = 1.7, OR versus Rate, p=.0012).
Conclusions: 1. Presence of TD comorbidity confers worse clinical outcomes in AF pts. 2. AF Treatment strategy does not uniformly affect CVH outcomes for TD. 3. Outcomes and drug tolerance worsen with Amio in AF pts with TD, while Rate control is superior to both Amio & OR in these pts.
- © 2010 by American Heart Association, Inc.