Evidence map›Paper›PMID 26525391›Full record

Trial reportClinical research in cardiology : official journal of the German Cardiac Society2016

Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial.

Marco Proietti, Valeria Raparelli, Brian Olshansky, Gregory Y H Lip

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Clinical research in cardiology : official journal of the German Cardiac Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 3 pooled it
5.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 3 syntheses or guidelines pooled it, 99 citations in OpenAlex.

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  14. Practical compendium of antiarrhythmic drugs: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 4 institutions in 4 countries.

Marco ProiettiCentre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK. marco.proietti@uniroma1.it.
Valeria RaparelliI Clinica Medica, Sapienza-University of Rome, Rome, Italy.
Brian OlshanskyDivision of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Gregory Y H LipCentre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK. g.y.h.lip@bham.ac.uk.
Aalborg University · DKBirmingham City Hospital · GBSapienza University of Rome · ITUniversity of Iowa Hospitals and Clinics · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPolypharmacy, as the use of five or more drugs, has commonly been associated with the elderly and multiple co-morbidities and related to impairment of clinical state and adverse outcomes, in general population. Limited data are available on the relationship between polypharmacy and adverse outcomes in atrial fibrillation (AF). We describe the prevalence of polypharmacy and AF, and its association with major adverse events, such as stroke and cardiovascular (CV) death. METHODS AND

resultsFor this study, we analysed all AFFIRM Trial patients with complete pharmacological data. Polypharmacy was recorded in 40 % of 4056 AF patients. The crude incidence of CV death was 3.45 % patient-years among patients with polypharmacy, vs 1.65 % patient-years without polypharmacy. Kaplan-Meier analysis showed that patients with polypharmacy had a higher cumulative incidence of CV death (p < 0.001). Cox regression analysis demonstrated that female gender (p = 0.038), diabetes mellitus (p = 0.029), previous myocardial infarction (MI) (p = 0.004), prior stroke (p = 0.011) and polypharmacy (p = 0.029) were independently associated with CV death. Polypharmacy was associated with an adjusted relative risk of 1.30 (95 % CI 1.03-1.64) for CV death. A linear increase in the number of drugs was significantly associated with CV death. No significant association was found with stroke occurrence.

conclusionsPolypharmacy is highly prevalent in AF patients and associated with a worse clinical outcome, conferring 30 % excess relative risk for CV death. Thus, polypharmacy may be a health status marker. Strategies to reduce inappropriate prescription and polypharmacy should be tested in prospective longitudinal studies of AF patients.

Indexed as

PolypharmacyAgedAtrial FibrillationCause of DeathComorbidityFemaleHealth Status IndicatorsHumansInappropriate PrescribingIncidenceKaplan-Meier EstimateMaleMiddle AgedPrevalencePrognosisProportional Hazards ModelsAtrial fibrillationCardiovascular deathPolypharmacy

Identifiers

PMID26525391
OpenAlexW1956185323

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.