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Original article| Volume 94, ISSUE 12, P2427-2436, December 2019

Long-Term Relationship Between Atrial Fibrillation, Multimorbidity and Oral Anticoagulant Drug Use

Published:October 23, 2019DOI:



      To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes.

      Patients and Methods

      We used data from the administrative health databases of Lombardy. All patients with AF and age 40 years and older and who were admitted to the hospital in 2002 were considered for analysis and followed up to 2014. AF diagnosis and CCI were established according to codes from the International Classification of Diseases, Ninth Revision.


      In 2002, 24,040 patients were admitted with a diagnosis of AF. CCI was higher in patients with AF than in those without AF (1.8±2.1 vs 0.2±0.9; P<.001). Over 12 years of follow-up, AF was associated with an increased risk of higher CCI (beta coefficient, 1.69; 95% CI, 1.67-1.70). In patients with AF, CCI was inversely associated with OAC prescription at baseline (P<.001) and at the end of the follow-up (P=.03). Patients with AF and a high CCI (≥4) had a higher cumulative incidence of stroke, major bleeding, and all-cause death (all P<.001), compared with those with low CCI (range, 0-3). Adjusted Cox regression analysis revealed that time-dependent continuous CCI was associated with an increased risk for stroke, major bleeding, and all-cause death (all P<.001).


      In hospitalized patients, AF is associated with an increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI is independently associated with an increased risk of stroke, major bleeding, and all-cause death.

      Abbreviations and Acronyms:

      ABC (Atrial Fibrillation Better Care), AF (atrial fibrillation), CCI (Charlson Comorbidity Index), CV (cardiovascular), ICD-9 (International Classification of Diseases, Ninth Revision), HR (hazard ratio), NOAC (non–vitamin K antagonist oral anticoagulant), OAC (oral anticoagulant), OR (odds ratio), VKA (vitamin K antagonist.)
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      Linked Article

      • Atrial Fibrillation and Multimorbidity
        Mayo Clinic ProceedingsVol. 94Issue 12
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          In this issue of Mayo Clinic Proceedings, Proietti et al1 evaluate the relationship between the Charlson comorbidity index (CCI) and atrial fibrillation (AF) in patients admitted to the hospital in the Lombardy region of Italy during the year 2002. The included patients were required to have AF as a discharge diagnosis and were analyzed for up to 14 years using data from the Italian National Health Service. As a control, a population 10-fold larger than the study group without AF was studied. Of 6 million eligible patients, more than 24,000 patients with a diagnosis of AF were included for analysis.
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