Tommaso Bucci, Dennis Wat, Sarah Sibley, Dan Wootton, David Green, Pasquale Pignatelli, Gregory Y H Lip, Freddy Frost
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The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405424/pdf/","citationCount":"0","resultStr":"{\"title\":\"Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease.\",\"authors\":\"Tommaso Bucci, Dennis Wat, Sarah Sibley, Dan Wootton, David Green, Pasquale Pignatelli, Gregory Y H Lip, Freddy Frost\",\"doi\":\"10.1007/s11739-024-03653-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. 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After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. 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引用次数: 0
摘要
小剂量阿奇霉素预防可改善慢性阻塞性肺病(COPD)频繁恶化患者的预后,但在心血管疾病患者中使用大环内酯类药物一直存在争议。目的:研究接受阿奇霉素预防治疗的心房颤动(房颤)患者在慢性阻塞性肺病(COPD)加重后发生不良事件的风险。在 TriNetX 平台上进行回顾性队列研究,包括患有慢性阻塞性肺病的房颤患者。研究记录了慢性阻塞性肺疾病加重后 30 天内的主要和次要结果风险,并对使用阿奇霉素和未使用阿奇霉素的患者进行了比较。主要结果是(1)心血管事件(全因死亡、心力衰竭、室性心律失常、缺血性中风、心肌梗死和心脏骤停)和(2)出血事件(颅内出血(ICH)和胃肠道出血)的复合风险。Cox回归分析比较了倾向评分匹配(PSM)后各组间的结果。经过倾向得分匹配后,与未使用阿奇霉素的患者(n = 2434,71 ± 10 岁,49% 为女性)相比,使用阿奇霉素的患者(n = 2434,72 ± 11 岁,51% 为女性)30 天内发生病情恶化后心血管疾病(HR 0.67,95% CI 0.61-0.73)和出血综合结果(HR 0.45,95% CI 0.32-0.64)的风险较低。除 ICH 外,对其他次要结果的有利影响是一致的。在敏感性分析中,阿奇霉素使用者发生不良事件的风险降低与吸烟状况、病情恶化严重程度和口服抗凝药类型无关。在患有慢性阻塞性肺病的房颤患者中,阿奇霉素预防性治疗可降低全因死亡、血栓和出血事件的风险。阿奇霉素预防作为慢性阻塞性肺病房颤患者综合护理管理的一部分可能发挥的作用还需要进一步研究。
Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease.
Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. To investigate the risk of adverse events after COPD exacerbations in patients with atrial fibrillation (AF) treated with azithromycin prophylaxis. Retrospective cohort study within the TriNetX Platform, including AF patients with COPD exacerbations. Risks of primary and secondary outcomes were recorded up to 30 days post-COPD exacerbations and compared between azithromycin users and azithromycin non-users. The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.
期刊介绍:
Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.