Oral anticoagulation across diabetic subtypes in patients with newly diagnosed atrial fibrillation: A report from the GARFIELD‐AF registry

• Published in: Diabetes, obesity & metabolism Vol. 25; no. 10; pp. 3040 - 3053
• Main Authors: Bassand, Jean‐Pierre, Virdone, Saverio, Camm, A. John, Fox, Keith A. A., Goldhaber, Samuel Z., Goto, Shinya, Haas, Sylvia, Hacke, Werner, Kayani, Gloria, Keltai, Matyas, Misselwitz, Frank, Pieper, Karen S., Turpie, Alexander G. G., Verheugt, Freek W. A., Kakkar, Ajay K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2023; Wiley Subscription Services, Inc
• Subjects: Anticoagulants; Antidiabetics; atrial fibrillation; Cardiac arrhythmia; cardiovascular disease; Cohort analysis; cohort study; Diabetes; Diabetes mellitus; Embolism; Fibrillation; Insulin; Mortality; Observational studies; observational study; oral anticoagulants; Patients; Population studies; Stroke; type 2 diabetes; cardiovascular disease; atrial fibrillation; cohort study; oral anticoagulants; type 2 diabetes; observational study
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.15202

Aims
This study aims to describe both management and prognosis of patients with diabetes mellitus (DM) and newly diagnosed atrial fibrillation (AF), overall as well as by antidiabetic treatment, and to assess the influence of oral anticoagulation (OAC) on outcomes by DM status.
Methods
The study population comprised 52 010 newly diagnosed patients with AF, 11 542 DM and 40 468 non‐DM, enrolled in the GARFIELD‐AF registry. Follow‐up was truncated at 2 years after enrolment. Comparative effectiveness of OAC versus no OAC was assessed by DM status using a propensity score overlap weighting scheme and weights were applied to Cox models.
Results
Patients with DM [39.3% oral antidiabetic drug (OAD), 13.4% insulin ± OAD, 47.2% on no antidiabetic drug] had higher risk profile, OAC use, and rates of clinical outcomes compared with patients without DM. OAC use was associated in patients without DM and patients with DM with lower risk of all‐cause mortality [hazard ratio 0.75 (0.69‐0.83), 0.74 (0.64‐0.86), respectively] and stroke/systemic embolism (SE) [0.69 (0.58‐0.83), 0.70 (0.53‐0.93), respectively]. The risk of major bleeding with OAC was similarly increased in patients without DM and those with DM [1.40 (1.14‐1.71), 1.37 (0.99‐1.89), respectively]. Patients with insulin‐requiring DM had a higher risk of all‐cause mortality and stroke/SE [1.91 (1.63‐2.24)], [1.57 (1.06‐2.35), respectively] compared with patients without DM, and experienced significant risk reductions of all‐cause mortality and stroke/SE with OAC [0.73 (0.53‐0.99); 0.50 (0.26‐0.97), respectively].
Conclusions
In both patients with DM and patients without DM with AF, OAC was associated with lower risk of all‐cause mortality and stroke/SE. Patients with insulin‐requiring DM derived significant benefit from OAC.