The COVID-19 pandemic is testing our society and is now a main topic in medicine. In addition to the COVID-19 burden, we still have to provide medical care to our other patients. In the June issue of the journal, we focus on subpopulations of patients with atrial fibrillation
Dr Hagengaard and co-workers from Denmark report differences in all-cause mortality risk in >14 000 Danish atrial fibrillation patients receiving co-treatment with diuretics and rate- or rhythm-controlling drugs with different serum potassium levels. They found excess mortality associated with hypokalaemia and hyperkalaemia, which is also known from other cardiovascular populations. However, the authors also observed increased mortality risk associated with low normal (3.5–3.7 mmol/L) and high normal (4.8–5.0 mmol/L) serum potassium groups. The authors suggest a need for an even narrower serum potassium interval in patients discharged following first-time hospitalization for atrial fibrillation. The risk of mortality associated with serum potassium abnormalities was not influenced by the type of rate- or rhythm-controlling drug.
Dr Shang-Hung Chang and co-workers from Taiwan compared the risk of major bleeding between atrial fibrillation patients who took non-vitamin-K antagonist oral anticoagulants (NOACs) and antiepileptic drugs (AEDs) concurrently and those who took only NOACs in a retrospective cohort study. The research group reported that in AF patients, the concurrent use of NOACs and valproic acid, phenytoin, or levetiracetam was associated with a higher risk of major bleeding.
In a study by Dr Coleman and co-workers from the USA, MarketScan data were used to identify oral anticoagulant (OAC)-naïve non-valvular atrial fibrillation (NVAF) patients receiving rivaroxaban or warfarin, with comorbid coronary artery disease (CAD) and/or peripheral artery disease (PAD). Differences in baseline covariates between cohorts were adjusted using propensity scores. The authors identified 3257 rivaroxaban users (30.4% received a 15 mg dose) and 5046 warfarin users with NVAF and comorbid CAD and/or PAD. The authors concluded that rivaroxaban was associated with a 32% reduction in the composite of major thrombotic vascular events, whereas no significant difference in major bleeding was observed.
In a post-hoc analysis of the ENGAGE AF-TIMI 48 trial, presented by Dr Giugliano and co-workers, the authors aimed to study the impact of non-cardiac comorbidities on the efficacy and safety profile of edoxaban compared with warfarin in patients with atrial fibrillation. Altogether, 21 105 patients with atrial fibrillation followed for an average of 2.8 years and randomized to either a higher dose edoxaban regimen (HDER), a lower dose edoxaban regimen (LDER), or warfarin were studied. The updated Charlson Comorbidity Index (CCI) was used to stratify the patients according to the burden of concomitant disease (CCI = 0, 1, 2, 3, and ≥4). The treatment groups were then compared for safety, efficacy, and net clinical outcomes across CCI categories. The authors concluded that although increasing CCI scores were associated with worse outcomes, the efficacy, safety, and net clinical outcomes of edoxaban vs. warfarin were independent of the degree of comorbidity present.
Generic medicinal products (GMPs) are low-priced copies of off-patent medicines that reduce healthcare costs and broaden access to healthcare. In a review paper, Dr Tamargo from Spain discusses whether the brand-name drugs and GMPs or the different GMPs are similar in purity, efficacy, and safety. The conclusion is that a global strategy that unifies the efforts of all the stakeholders, including drug manufacturers, healthcare providers, Governments, health professionals, patients, and judicial systems are needed to protect the drug chain supply and ensure that only high-quality GMPs are available for use.
Finally, Dr Ruilope and co-workers from Spain present a review entitled ‘Resistant hypertension: new insights and therapeutic perspectives’.
Our mission: To reduce the burden of cardiovascular disease.