- Among patients with Afib, insulin-requiring diabetes (IRD) is associated with heightened thromboembolic and atherothrombotic outcome risk compared with non-IRD (NIRD) and nondiabetes (ND).
- IRD may derive least risk reduction from anticoagulation.
Why this matters
- Diabetes mellitus (DM) is present in about 15% of patients with Afib, and significantly increases cardiovascular event risk.
- Retrospective data analysis of 798,592 Medicare beneficiaries (6.7% IRD, 31.3% NIRD, 62% ND).
- Funding: US Agency for Healthcare Research and Quality, Department of Veterans Affairs.
- In adjusted model, IRD had higher stroke risk than NIRD and ND:
- HRs, 1.15 and 1.24, respectively (both P<.001>
- NIRD had higher stroke risk than ND:
- HR, 1.08 (P<.001>
- Overall HR for stroke with anticoagulant use was 0.85 (P<.001>
- Anticoagulants prevented stroke in:
- ND: HR, 0.74 (P<.001>
- NIRD: 0.86 (P<.001>
- But not in IRD: 0.94 (P=.09).
- Prognostic variables (i.e., diabetes duration, HbA1c, insulin dose) lacking.
- MI definition based on ICD-9.
- Short follow-up after Afib diagnosis.
- No control for anticoagulation adherence.