ORLANDO – Patients with atrial fibrillation have an underappreciated high rate of gastrointestinal events, including dyspepsia, GI bleeds, diverticulitis, and gastroesophageal reflux disease.
The rate of symptomatic GI events in patients with atrial fibrillation (AF) rises with increasing CHADS2 score and age. In those AF patients at increased risk for GI events – elderly patients with a higher CHADS2 score – it makes sense for physicians to steer clear whenever possible of the many medications known to increase GI symptoms, Dr. François Laliberté advised at the annual scientific session of the American Heart Association.
He presented an analysis of insurance claims data from the Thomson Reuters MarketScan database for 2005-2009. The study included 413,618 adults diagnosed for the first time with AF and who had no GI events in the 180 days immediately beforehand.
During a mean follow-up of 563 days, the incidence of any diagnosed GI event among these patients – all free of GI symptoms at baseline – was 38.8 events per 100 patient-years, or roughly 39%.
By far the most common GI event was dyspepsia, with an incidence of 14.7 cases per 100 patient-years. This was followed in frequency by diverticula of the intestine at 5.2, gastroesophageal reflux disease at 4.8, and GI bleeding at 4.3 cases per 100 patient-years, reported Dr. Laliberté of the Analysis Group, Montreal.
The rate of GI-related hospitalization was 9.7 per 100 patient-years.
The incidence of GI events was gender-related: 43.6 per 100 patient-years among women with AF and 35.5 in men. The GI event rate steadily rose with age, from 32.2 events per 100 patient-years in patients under age 65 to 52.7 in those age 85 and up.
Patients with a CHADS2 score of 0 had a GI event rate of 30.3 per 100 patient-years. The rate climbed steeply to 41.6 with a CHADS2 score of 1-2, 56.9 with a CHADS2 of 3-4, and 74.5 in patients with a CHADS2 of 5-6.
At baseline, 62% of the AF patients were on one or more medications known to increase the risk of GI events. Leading the list were anticoagulants, used by 19.4% of the study population. Other commonly used medications that promote GI toxicity included opioids, antiplatelet agents, corticosteroids, NSAIDs, selective serotonin receptor inhibitors, bisphosphonates, and calcium channel blockers.
This study was funded by Janssen Scientific Affairs.