Abstract 9213: Risk of Gastrointestinal Conditions Among Patients with Atrial Fibrillation
Objective: There are limited data suggesting that gastrointestinal (GI) conditions are common in patients with atrial fibrillation (AF). However, AF patients are generally older, and, many agents utilized by patients with AF are known to increase the risk of GI events. The objective of this study was to describe the risk of GI events among patients with AF.
Design: An analysis of insurance healthcare claims from the Thomson Reuters MarketScan® database was conducted. Over the period from 2005 to 2009, all subjects aged ≥18 years as of the date of first AF diagnosis, with ≥180 days of continuous insurance coverage prior to the index AF and no GI event within 180 days of the index AF were selected. GI events were identified from claims with a primary or secondary diagnosis code for any GI condition and for the subset of GI conditions consistent with dyspepsia (upper abdominal pain, abdominal pain, abdominal discomfort and dyspepsia). The risk of GI events was assessed with incidence rates (IRs) (new GI cases / patient-years of observation). Subgroup analyses were performed with respect to gender, age and CHADS2 score.
Results: A total of 413,168 patients with AF and no GI event in the 180-day baseline period were identified. The mean (median; SD) age of all patients with AF was 67.7 years (69; 15); 43% were female. During follow-up (mean of 563 days), IRs of any GI event and dyspepsia for patients with AF but no GI symptoms at baseline were 38.8 and 14.7 events per 100 patient-years. Corresponding IRs of any GI events for female and male were 43.6 and 35.5; for patients in the age groups below 65, 65-74, 75-84 and ≥85 years IRs were 32.3, 38.9, 44.6 and 52.7; for patients with CHADS2 score of 0, 1-2, 3-4 and 5-6 IRs were 30.3, 41.6, 56.9 and 74.5, respectively. At baseline, 257,357 patients (62%) had at least one medication dispensed which may cause GI tolerability issues.
Conclusions: In this large claims database, AF was associated with a high IR of GI events. A rising trend in IR was observed with increasing age and CHADS2 score. Higher propensity for GI events (such as dyspepsia) and agents that selectively cause higher symptomatic GI rates may relate to poor medication adherence in AF patients. Therefore, prescribers should take subgroup characteristics of this population into consideration.
- © 2011 by American Heart Association, Inc.