Abstract 12862: Predictors of Hospitalization and Effects of Dabigatran and Warfarin on Hospitalization Rates: An Analysis From The Re-ly Trial
Introduction: Hospitalization is common in patients with atrial fibrillation (AF), and predicts poor prognosis, but is poorly understood.
Aim: We evaluated predictors of hospitalization in patients with AF treated with dabigatran etexilate (DE) or warfarin in RE-LY to understand predictors of hospitalization and to further evaluate the effects of anticoagulant choices on hospitalization.
Methods: A multivariate regression model was developed to determine predictors of hospitalization. Hospitalization due to bleeding events were identified and rates were compared between DE and warfarin.
Results: Of 18,113 patients in RE-LY, 7,200 (39.8%) were hospitalized at least once during mean follow up of 2 years, with 14,025 total hospitalizations. Compared to patients not hospitalized, patients with hospitalizations were older, more often had coronary artery disease, prior MI, a history of heart failure, moderate renal impairment, hypertension, diabetes and higher CHADS2 scores. Multivariate analysis identified peripheral artery disease (PAD; HR 1.44, 95% CI 1.22-1.69), a CHADS2 score of ≥ 3 (HR 1.29, CI 1.11-1.51), VKA-naïve (HR 1.28, CI 1.19-1.37), left ventricular ejection fraction (EF) ≤ 40% (HR 1.24, CI 1.12-1.36), and renal impairment with CrCL ≤ 50mL/min (HR 1.12, CI 1.02-1.23) as predictors of hospitalization. First hospitalization rates were 39.5%, 41.6% and 42.6% for DE 110 mg bid, DE 150 mg bid and warfarin, respectively. The treatment effects of both DE doses compared to warfarin were consistent, between patients hospitalized and those not. Hospitalization occurred less often with DE 110 compared to warfarin (RR = 0.93, CI 0.87-0.99) and compared to DE 150 (RR=0.95, CI 0.89-1.01). Hospitalizations for bleeding events occurred less often with DE 110 (3.5%) compared both to warfarin (4.6%) (p=0.02) and to DE 150 (5.2%) (p<0.001); rates were statistically similar between DE 150 and warfarin (p=0.07).
Conclusion: Predictors of hospitalization included common comorbidities of an elderly AF population, such as PAD, higher CHADS2 scores, low EF and renal impairment. DE 110 mg bid was associated with significantly fewer hospitalizations compared to both warfarin and DE 150 bid; in part due to reduction in hospitalizations for bleeding events.
Author Disclosures: A. Merali: Research Grant; Modest; S Yusuf received research grant money/honoraria from Boehringer Ingelheim. Speakers Bureau; Modest; MD Ezekowitz was on the Speakers Bureau for Boehringer Ingelheim. Honoraria; Modest; L Wallentin received honoraria from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Eli Lilly, Schering-Plough, and Bristol-Myers Squibb. Consultant/Advisory Board; Modest; MD Ezekowitz has served as a consultant for AstraZeneca, MD Ezekowitz has served as a consultant for Eisai, Pozen Inc., MD Ezekowitz has served as a consultant for Boehringer Ingelheim, MD Ezekowitz has served as a consultant for ARYx Therapeutics, Pfizer, Sanofi, MD Ezekowitz has served as a consultant for Bristol-Myers Squibb, Portola, Daiichi Sanko, Medtronic, Merck, Johnson & Johnson, Gilead and Janssen Scientific Affairs, S Yusuf served as a consultant for Boehringer Ingelheim, AstraZeneca, Sanofi-Aventis, and Bristol-Myers Squibb, L Wallentin had served as consultant for Boehringer Ingelheim, Regado Biosciences, Athera Biosciences, Astra Zeneca, GlaxoSmithKline, Eli Lilly, Schering-Plough, and Bristol-Myers Squibb. Other; Modest; S. Connolly has received personal fees from Portola, grants from Boston Scientific. Employment; Significant; M Brueckmann, and M Fraessforf are employees of Boehringer Ingelheim. Research Grant; Significant; S Connolly has received grants and personal fees from Boehringer-Ingelheim, Bristol-Myers Squibb, Sanofi Aventis, Bayer,, S Connolly has received Institutional research grant from Boehringer-Ingelheim., L Wallentin received research grant money from Boehringer Ingelheim, AstraZeneca, Glaxo Smith Kline, Schering-Plough, and Bristol-Myers Squibb. Other; Significant; The study was funded by Boehringer Ingelheim. A. Alak: None. S.J. Connolly: None. M. Fraessdorf: None. M. Brueckmann: None. M.D. Ezekowitz: None. P. Reilly: None. S. Yusuf: None. L. Wallentin: Honoraria; Modest; Boehringer-Ingelheim, AstraZeneca, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline. Consultant/Advisory Board; Modest; Merck & Co, Boehringer-Ingelheim, AstraZeneca, GlaxoSmithKline, Bristol-Myers Squibb/Pfizer. Research Grant; Significant; AstraZeneca, Merck & Co, Boehringer-Ingelheim, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline.
- © 2015 by American Heart Association, Inc.