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Open Access Research

Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation – a cohort study from Sweden using propensity score analyses

Per Wändell1*, Axel C Carlsson12, Jan Sundquist34, Sven-Erik Johansson3, Matteo Bottai5 and Kristina Sundquist34

Author Affiliations

1 Centre for Family Medicine, Karolinska Institutet, Alfred Nobels Allé 12, S-141 83 Huddinge, Sweden

2 Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

3 Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden

4 Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA

5 Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

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Diabetology & Metabolic Syndrome 2014, 6:2  doi:10.1186/1758-5996-6-2

Published: 7 January 2014

Abstract

Aims

To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care.

Methods

Study population consisted of men (n = 1319) and women (n = 1094) aged ≥45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy).

Results

Overall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients < 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged ≥80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those <80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients < 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those ≥80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52).

Conclusions

Our findings suggest that antiplatelets could exert a beneficial effect among those above 80 years.

Keywords:
Antithrombotic drugs; Statins; Pharmacotherapy; Mortality; Follow-up