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Effect of cardiovascular drug classes on all-cause mortality among atrial fibrillation patients treated in primary care in Sweden: a cohort study

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Background

Risk factors for stroke are well known in atrial fibrillation (AF) patients, while less is known on the effect of these factors on total mortality.

Objective

Our aim was to study the impact of cardiovascular drug classes on mortality in AF patients treated in primary care.

Methods

The study population was chosen based on patient data from 75 primary care centres in Sweden compiled in a database. Individuals diagnosed with AF who were older than 45 years were enrolled (n = 12,302, of whom 6,660 were men). Cox regression analysis with mortality (years to death) as outcome was conducted in the men and women separately, as well in the age categories <80 and ≥80 years, with cardiovascular drugs as independent factors, and age, cardiovascular diagnoses and educational level as covariates.

Results

Lower mortality was shown for anticoagulant treatment among men, both younger (<80 years) [adjusted hazard ratio (HR) 0.43, 95 % confidence interval (CI) 0.31–0.61] and older (≥80 years) (adjusted HR 0.47, 95 % CI 0.32–0.69), and among younger women (adjusted HR 0.46, 95 % CI 0.29–0.74), and for antiplatelet treatment in older men (adjusted HR 0.51, 95 % CI 0.35–0.74). Treatment with thiazides was associated with lower mortality among younger men (adjusted HR 0.68, 95 % CI 0.48–0.96), older men (adjusted HR 0.67, 95 % CI 0.46–0.98) and older women (adjusted HR 0.70, 95 % CI 0.52–0.94). Statins were associated with lower mortality among younger patients, in both men (adjusted HR 0.47, 95 % CI 0.32–0.68) and women (adjusted HR 0.54, 95 % CI 0.35–0.82).

Conclusions

The differences in age and gender patterns need further exploration.

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Acknowledgements

This work was supported by the Swedish Research Council and King Gustav V and Queen Victoria’s Freemasons Foundation.

Disclosures

The authors have no conflict of interest to disclose.

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Authors and Affiliations

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

    Per Wändell & Axel C. Carlsson

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

    Axel C. Carlsson

  3. Center for Primary Health Care Research, Lund University, Malmö, Sweden

    Kristina Sundquist, Sven-Erik Johansson & Jan Sundquist

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

    Kristina Sundquist & Jan Sundquist

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  1. Per Wändell
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  2. Axel C. Carlsson
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  5. Jan Sundquist
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Correspondence to Per Wändell.

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Wändell, P., Carlsson, A.C., Sundquist, K. et al. Effect of cardiovascular drug classes on all-cause mortality among atrial fibrillation patients treated in primary care in Sweden: a cohort study. Eur J Clin Pharmacol 69, 279–287 (2013). https://doi.org/10.1007/s00228-012-1395-2

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  • DOI: https://doi.org/10.1007/s00228-012-1395-2

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