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

Bassand, JP; Virdone, S; Camm, AJ; Fox, KAA; Goldhaber, SZ; Goto, S; Haas, S; Hacke, W; Kayani, G; Keltai, M; Misselwitz, F; Pieper, KS; Turpie, AGG; Verheugt, FWA; Kakkar, AK; GARFIELD-AF Investigators

doi:10.1111/dom.15202

Type 2 & other diabetes

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

Diabetes Obes MetabPublished 12 Jul 2023Registry-based cohort study

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Authors' conclusion

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.

Study context

Population: Patients with newly diagnosed AF enrolled in the GARFIELD-AF registry, 11,542 with diabetes mellitus (DM) and 40,468 without DM11,542 DM, 40,468 non-DM
Participants: 52,010 patients

Exposure: Oral anticoagulation (OAC) vs no OAC, by DM status
Outcome: All-cause mortality, OAC vs no OAC, by DM status
Follow-up: 2 years

Methodological detailspropensity score overlap weighting, Cox models

Propensity score overlap weighting
Cox models

Main finding

As reported in the abstract

OAC vs No OACHazard ratio (CI)

Patients without DM

0.75(0.69–0.83)

Patients with DM

0.74(0.64–0.86)

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk ←→ Higher risk →	HR (CI)
Stroke/SE, OAC vs no OAC, by DM status · 2 yearsOACvs No OACPatients without DM	0.20.5125	0.69 (0.58–0.83)
Stroke/SE, OAC vs no OAC, by DM status · 2 yearsOACvs No OACPatients with DM	0.20.5125	0.70 (0.53–0.93)
Insulin-requiring DM vs no DM: risk of all-cause mortality and stroke/SEInsulin-requiring DMvs No DMAll-cause mortality	0.20.5125	1.91 (1.63–2.24)
Insulin-requiring DM vs no DM: risk of all-cause mortality and stroke/SEInsulin-requiring DMvs No DMstroke/SE	0.20.5125	1.57 (1.06–2.35)
OAC vs no OAC in insulin-requiring DMOACvs No OACAll-cause mortality	0.20.5125	0.73 (0.53–0.99)
OAC vs no OAC in insulin-requiring DMOACvs No OACstroke/SE	0.20.5125	0.50 (0.26–0.97)
	0.20.5125Hazard ratio (log scale)

Antidiabetic treatment in DM

Oral antidiabetic drug (OAD): 39.3%
Insulin ± OAD: 13.4%
No antidiabetic drug: 47.2%

Safety

Outcome	← Lower risk with OAC ←→ Higher risk with OAC →	HR (CI)
Major bleeding, OAC vs no OAC, by DM status · 2 yearsOACvs No OACPatients without DM	0.512	1.40 (1.14–1.71)
Major bleeding, OAC vs no OAC, by DM status · 2 yearsOACvs No OACPatients with DM	0.512	1.37 (0.99–1.89)
	0.512Hazard ratio (log scale)

Original publication

Oral anticoagulation across diabetic subtypes in patients with newly diagnosed atrial fibrillation: A report from the GARFIELD‐AF registry. Diabetes Obes Metab. Published 12 July 2023. doi:10.1111/dom.15202

Read the original article ↗

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