Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

Abstract

AimsTo assess the impact of anticoagulant treatment on risk for stroke and all-cause mortality of patients with atrial fibrillation using real-world data (RWD).MethodsPatients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, hemorrhagic stroke, and all-cause mortality were identified in the claims of the electronic health records (EHRs). Subjects were classified according to the anticoagulant treatment in four groups: untreated, vitamin K antagonists (VKAs), New Oral Anticoagulants (NOACs), and antiplatelet (AP). Risk of events and protection with anticoagulant therapy were calculated by Cox proportional hazard models adjusted by potential confounders.ResultsFrom a total population of 3,799,884 patients older than 18,123,227 patients with incident or prevalent atrial fibrillation (AF) were identified (mean age 75.2 ± 11.5 years old; 51.9% women). In a follow-up average of 3.2 years, 17,113 patients suffered from an ischemic stroke and transitory ischemic attack (TIA), 780 hemorrhagic stroke, and 42,558 all-cause death (incidence of 46, 8, 2, and 120 per 1,000 patients/year, respectively). Among CHA2DS2, VASc Score equal or >2, 11.7% of patients did not receive any anticoagulant therapy, and a large proportion of patients, 47%, shifted from one treatment to another. Although all kinds of anticoagulant treatments were significantly protective against the events and mortality, NOAC treatment offered significantly better protection compared to the other groups.ConclusionIn the real world, the use of anticoagulant treatments is far from guidelines recommendations and is characterized by variability in their use. NOACs offered better protection compared with VKAs.

Sex and gender differences in the use of oral anticoagulants for non-valvular atrial fibrillation: A population-based cohort study in primary health care in catalonia

“…There were more men in our study, as they are more frequently affected by AF ( Hindricks et al, 2021 ). Comorbidities and risk of stroke and bleeding were similar to those described in prior investigations ( Basaran et al, 2017 ; Giner-Soriano et al, 2020 ; Calderon et al, 2022 ), also with differences between men and women as previously described, as Loikas et al, who examined sex and gender differences in thromboprophylaxis in patients with NVAF. They reported more men with the disease but women with higher CHA 2 DS 2 VASc, as in our study.…”

“…Several authors have described the trends of use of OAC for stroke prevention in NVAF in the recent years ( Basaran et al, 2017 ; Wilkinson et al, 2021 ; Calderon et al, 2022 ). From 2014 to 2017, there were more patients with NVAF initiating OAC in our setting (from 67.9% to 81.9%), with an increase of DOAC over time ( Programa d’harmonització farmacoterapèutica et al, 2019 ; Giner-Soriano et al, 2020 ).…”

Clinical Outcomes in Older Patients with Atrial Fibrillation: Insights from the GARFIELD-AF Registry

“…However, atrial fibrillation itself contributes to adverse outcomes by increasing the risk of stroke, diminishing cardiac performance, and exposing symptomatic patients to therapies that also have risks, such as antiarrhythmic medications and ablation. 1 Older age is a major risk factor for developing atrial fibrillation and its sequelae such as stroke or systemic embolism, heart failure, 2 acute coronary syndrome, 3 and an increased risk of death. 4 The reported prevalence of atrial fibrillation is at least 10% among those older than age 80 years.…”

Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands

“…However, it has not been thoroughly investigated whether stroke prevention has improved along with these advances in anticoagulation at the population level. Since evidence from clinical trials may lack generalizability 18 , 19 and adherence to guidelines could be suboptimal, 20 an update obtained from population-level data can be highly relevant to both clinical practice and research. To fill this knowledge gap, we investigated time trends in patient characteristics, anticoagulation treatment, and prognosis of patients with incident AF between 2014 and 2018 in the Netherlands.…”