Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant

Brown, Louise A.; Boos, Christopher J.

doi:10.1016/j.ijcard.2016.09.086

Cited by 11 publications

(3 citation statements)

References 79 publications

(92 reference statements)

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“…HF is an independent predictor of stroke in patients with AF,3 but it is also often associated with conditions determining higher bleeding risk (higher age, renal, liver disease) 17. Additionally, AF patients with concomitant HF using warfarin have been shown to spend less time in therapeutic range compared with those with AF alone, suggesting more difficult anticoagulation management 18 19.…”

Section: Discussionmentioning

confidence: 99%

Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure

Savarese

Sartipy

Friberg

et al. 2018

Heart

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Section: Discussionmentioning

confidence: 99%

Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure

Savarese

Sartipy

Friberg

et al. 2018

Heart

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“…Furthermore, the risk of thromboembolism is unrelated to the severity of LV dysfunction or NYHA functional class. 54) 55) 56) …”

Section: Balancing the Risk Of Stroke And Anticoagulationmentioning

confidence: 99%

Atrial Fibrillation in Heart Failure: a Therapeutic Challenge of Our Times

Batul

Gopinathannair

2017

Korean Circ J

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Atrial fibrillation (AF) and heart failure (HF) are growing cardiovascular disease epidemics worldwide. There has been an exponential increase in the prevalence of AF and HF correlating with an increased burden of cardiac risk factors and improved survival rates in patients with structural heart disease. AF is associated with adverse prognostic outcomes in HF and is most evident in mild-to-moderate left ventricular (LV) dysfunction where the loss of “atrial kick” translates into poorer quality of life and increased mortality. In the absence of underlying structural heart disease, arrhythmia can independently contribute to the development of cardiomyopathy. Together, these 2 conditions carry a high risk of thromboembolism due to stasis, inflammation and cellular dysfunction. Stroke prevention with oral anticoagulation (OAC) remains a mainstay of treatment. Pharmacologic rate and rhythm control remain limited by variable efficacy, intolerance and adverse reactions. Catheter ablation for AF has resulted in a paradigm shift with evidence indicating superiority over medical therapy. While its therapeutic success is high for paroxysmal AF, it remains suboptimal in persistent AF. A better mechanistic understanding of AF as well as innovations in ablation technology may improve patient outcomes in the future. Refractory cases may benefit from atrioventricular junction ablation and biventricular pacing. The value of risk factor modification, especially with regard to obesity, sleep apnea, hypertension and diabetes, cannot be emphasized enough. Close interdisciplinary collaboration between HF specialists and electrophysiologists is an essential component of good long-term outcomes in this challenging population.

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“…Some existing studies have evaluated the efficacy and safety of NOACs versus those of warfarin for stroke prevention in AF patients already coexisting with HF [ 44 , 45 ]. However, to our knowledge, evidence regarding the risk of incident HF in those treated with NOACs versus those treated with warfarin is still lacking.…”

Section: Discussionmentioning

confidence: 99%

Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study

Lin

Liu

et al. 2023

Cardiovasc Diabetol

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Background Heart failure (HF) is a critical complication in elderly patients with atrial fibrillation (AF) and diabetes mellitus (DM). Recent preclinical studies suggested that non-vitamin K antagonist oral anticoagulants (NOACs) can potentially suppress the progression of cardiac fibrosis and ischemic cardiomyopathy. Whether different oral anticoagulants influence the risk of HF in older adults with AF and DM is unknown. This study aimed to evaluate the risk of HF in elderly patients with AF and DM who were administered NOACs or warfarin. Methods A nationwide retrospective cohort study was conducted based on claims data from the entire Taiwanese population. Target trial emulation design was applied to strengthen causal inference using observational data. Patients aged ≥ 65 years with AF and DM on NOAC or warfarin treatment between 2012 and 2019 were included and followed up until 2020. The primary outcome was newly diagnosed HF. Propensity score-based fine stratification weightings were used to balance patient characteristics between NOAC and warfarin groups. Hazard ratios (HRs) were estimated using Cox proportional hazard models. Results The study included a total of 24,835 individuals (19,710 NOAC and 5,125 warfarin users). Patients taking NOACs had a significantly lower risk of HF than those taking warfarin (HR = 0.80, 95% CI 0.74–0.86, p < 0.001). Subgroup analyses for individual NOACs suggested that dabigatran (HR = 0.86, 95% CI 0.80–0.93, p < 0.001), rivaroxaban (HR = 0.80, 95% CI 0.74–0.86, p < 0.001), apixaban (HR = 0.78, 95% CI 0.68–0.90, p < 0.001), and edoxaban (HR = 0.72, 95% CI 0.60–0.86, p < 0.001) were associated with lower risks of HF than warfarin. The findings were consistent regardless of age and sex subgroups and were more prominent in those with high medication possession ratios. Several sensitivity analyses further supported the robustness of our findings. Conclusions This nationwide cohort study demonstrated that elderly patients with AF and DM taking NOACs had a lower risk of incident HF than those taking warfarin. Our findings suggested that NOACs may be the preferred oral anticoagulant treatment when considering the prevention of heart failure in this vulnerable population. Future research is warranted to elucidate causation and investigate the underlying mechanisms.

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Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant

Cited by 11 publications

References 79 publications

Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure

Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure

Atrial Fibrillation in Heart Failure: a Therapeutic Challenge of Our Times

Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study

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