Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients
Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Older age is strongly associated with stroke, HF, and mortality. The association between coexistence of HF and a risk of clinical outcomes and the effectiveness of anticoagulation therapy including direct oral anticoagulant...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14550 |
| _version_ | 1797242793107652608 |
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| author | Shota Ikeda Ken‐ichi Hiasa Hiroshi Inoue Takeshi Yamashita Masaharu Akao Hirotsugu Atarashi Yukihiro Koretsune Ken Okumura Wataru Shimizu Shinya Suzuki Takanori Ikeda Kazunori Toyoda Atsushi Hirayama Masahiro Yasaka Takenori Yamaguchi Satoshi Teramukai Tetsuya Kimura Yoshiyuki Morishima Atsushi Takita Hiroyuki Tsutsui |
| author_facet | Shota Ikeda Ken‐ichi Hiasa Hiroshi Inoue Takeshi Yamashita Masaharu Akao Hirotsugu Atarashi Yukihiro Koretsune Ken Okumura Wataru Shimizu Shinya Suzuki Takanori Ikeda Kazunori Toyoda Atsushi Hirayama Masahiro Yasaka Takenori Yamaguchi Satoshi Teramukai Tetsuya Kimura Yoshiyuki Morishima Atsushi Takita Hiroyuki Tsutsui |
| author_sort | Shota Ikeda |
| collection | DOAJ |
| description | Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Older age is strongly associated with stroke, HF, and mortality. The association between coexistence of HF and a risk of clinical outcomes and the effectiveness of anticoagulation therapy including direct oral anticoagulants (DOACs) in elderly patients with AF and HF have not been investigated. We aimed to evaluate 2 years of outcomes and to elucidate the efficacy of DOACs or warfarin in elderly AF patients in the All Nippon AF In the Elderly (ANAFIE) Registry with and without a history of HF. Methods and results The ANAFIE Registry is a multicentre, prospective observational study following elderly non‐valvular AF patients aged ≥75 years for 2 years. Hazard ratios (HRs) were calculated based on the presence or absence of an HF diagnosis and DOAC or warfarin use at enrolment. Among 32 275 eligible patients, 12 116 (37.5%) had been diagnosed with HF. Patients with HF had significantly higher rates of HF hospitalization or cardiovascular death (HR 1.94, P < 0.001), cardiovascular events (HR 1.59, P < 0.001), cardiovascular death (HR 1.49, P < 0.001), all‐cause death (HR 1.32, P < 0.001), and net clinical outcome including stroke/systemic embolism, major bleeding, and all‐cause death (HR 1.23, P < 0.001), compared with those without HF; however, HRs for stroke/systemic embolism (HR 0.96, P = 0.56) and major bleeding (HR 1.14, P = 0.13) were similar. DOAC use was associated with a low risk of stroke/systemic embolism (HR 0.86, P = 0.19 in HF; HR 0.79, P = 0.016 in non‐HF; P for interaction = 0.56), major bleeding (HR 0.71, P = 0.008 in HF; HR 0.75, P = 0.016 in non‐HF; P for interaction = 0.74), HF hospitalization or cardiovascular death (HR 0.81, P < 0.001 in HF; HR 0.78, P < 0.001 in non‐HF; P for interaction = 0.26), cardiovascular events (HR 0.83, P < 0.001 in HF; HR 0.82, P = 0.001 in non‐HF; P for interaction = 0.65), cardiovascular death (HR 0.84, P = 0.12 in HF; HR 0.75, P = 0.035 in non‐HF; P for interaction = 0.18), all‐cause death (HR 0.89, P = 0.082 in HF; HR 0.80, P = 0.001 in non‐HF; P for interaction = 0.091), and net clinical outcome (HR 0.88, P = 0.019 in HF; HR 0.81, P < 0.001 in non‐HF; P for interaction = 0.21) compared with warfarin, irrespective of the presence or absence of HF. Analysis using the propensity score matching method showed similar associations. Conclusions Non‐valvular AF patients aged ≥75 years with a history of HF had higher risks of cardiovascular events and mortality. DOACs were favourable to warfarin regardless of the coexistence of HF. These results might encourage the use of DOACs in elderly patients with non‐valvular AF with or without HF. |
| first_indexed | 2024-04-24T18:44:52Z |
| format | Article |
| id | doaj.art-0a754050a79a45b19691e9ce048af2b0 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-24T18:44:52Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-0a754050a79a45b19691e9ce048af2b02024-03-27T06:48:03ZengWileyESC Heart Failure2055-58222024-04-0111290291310.1002/ehf2.14550Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patientsShota Ikeda0Ken‐ichi Hiasa1Hiroshi Inoue2Takeshi Yamashita3Masaharu Akao4Hirotsugu Atarashi5Yukihiro Koretsune6Ken Okumura7Wataru Shimizu8Shinya Suzuki9Takanori Ikeda10Kazunori Toyoda11Atsushi Hirayama12Masahiro Yasaka13Takenori Yamaguchi14Satoshi Teramukai15Tetsuya Kimura16Yoshiyuki Morishima17Atsushi Takita18Hiroyuki Tsutsui19Department of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University 3‐1‐1 Maidashi, Higashi‐ku Fukuoka 812‐8582 JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University 3‐1‐1 Maidashi, Higashi‐ku Fukuoka 812‐8582 JapanSaiseikai Toyama Hospital Toyama JapanDepartment of Cardiovascular Medicine The Cardiovascular Institute Tokyo JapanDepartment of Cardiology National Hospital Organization Kyoto Medical Center Kyoto JapanAOI Hachioji Hospital Tokyo JapanInstitute for Clinical Research National Hospital Organization Osaka National Hospital Osaka JapanDivision of Cardiology Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine Nippon Medical School Tokyo JapanDepartment of Cardiovascular Medicine The Cardiovascular Institute Tokyo JapanDepartment of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanOsaka Police Hospital Osaka JapanDepartment of Cerebrovascular Medicine and Neurology Cerebrovascular Center, National Hospital Organization Kyushu Medical Center Fukuoka JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Biostatistics, Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto JapanPrimary Medical Science Department Daiichi Sankyo Co., Ltd. Tokyo JapanPrimary Medical Science Department Daiichi Sankyo Co., Ltd. Tokyo JapanData Intelligence Department Daiichi Sankyo Co., Ltd. Tokyo JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University 3‐1‐1 Maidashi, Higashi‐ku Fukuoka 812‐8582 JapanAbstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Older age is strongly associated with stroke, HF, and mortality. The association between coexistence of HF and a risk of clinical outcomes and the effectiveness of anticoagulation therapy including direct oral anticoagulants (DOACs) in elderly patients with AF and HF have not been investigated. We aimed to evaluate 2 years of outcomes and to elucidate the efficacy of DOACs or warfarin in elderly AF patients in the All Nippon AF In the Elderly (ANAFIE) Registry with and without a history of HF. Methods and results The ANAFIE Registry is a multicentre, prospective observational study following elderly non‐valvular AF patients aged ≥75 years for 2 years. Hazard ratios (HRs) were calculated based on the presence or absence of an HF diagnosis and DOAC or warfarin use at enrolment. Among 32 275 eligible patients, 12 116 (37.5%) had been diagnosed with HF. Patients with HF had significantly higher rates of HF hospitalization or cardiovascular death (HR 1.94, P < 0.001), cardiovascular events (HR 1.59, P < 0.001), cardiovascular death (HR 1.49, P < 0.001), all‐cause death (HR 1.32, P < 0.001), and net clinical outcome including stroke/systemic embolism, major bleeding, and all‐cause death (HR 1.23, P < 0.001), compared with those without HF; however, HRs for stroke/systemic embolism (HR 0.96, P = 0.56) and major bleeding (HR 1.14, P = 0.13) were similar. DOAC use was associated with a low risk of stroke/systemic embolism (HR 0.86, P = 0.19 in HF; HR 0.79, P = 0.016 in non‐HF; P for interaction = 0.56), major bleeding (HR 0.71, P = 0.008 in HF; HR 0.75, P = 0.016 in non‐HF; P for interaction = 0.74), HF hospitalization or cardiovascular death (HR 0.81, P < 0.001 in HF; HR 0.78, P < 0.001 in non‐HF; P for interaction = 0.26), cardiovascular events (HR 0.83, P < 0.001 in HF; HR 0.82, P = 0.001 in non‐HF; P for interaction = 0.65), cardiovascular death (HR 0.84, P = 0.12 in HF; HR 0.75, P = 0.035 in non‐HF; P for interaction = 0.18), all‐cause death (HR 0.89, P = 0.082 in HF; HR 0.80, P = 0.001 in non‐HF; P for interaction = 0.091), and net clinical outcome (HR 0.88, P = 0.019 in HF; HR 0.81, P < 0.001 in non‐HF; P for interaction = 0.21) compared with warfarin, irrespective of the presence or absence of HF. Analysis using the propensity score matching method showed similar associations. Conclusions Non‐valvular AF patients aged ≥75 years with a history of HF had higher risks of cardiovascular events and mortality. DOACs were favourable to warfarin regardless of the coexistence of HF. These results might encourage the use of DOACs in elderly patients with non‐valvular AF with or without HF.https://doi.org/10.1002/ehf2.14550Heart failureAtrial fibrillationElderly patientsDirect oral anticoagulantWarfarinAnticoagulation |
| spellingShingle | Shota Ikeda Ken‐ichi Hiasa Hiroshi Inoue Takeshi Yamashita Masaharu Akao Hirotsugu Atarashi Yukihiro Koretsune Ken Okumura Wataru Shimizu Shinya Suzuki Takanori Ikeda Kazunori Toyoda Atsushi Hirayama Masahiro Yasaka Takenori Yamaguchi Satoshi Teramukai Tetsuya Kimura Yoshiyuki Morishima Atsushi Takita Hiroyuki Tsutsui Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients ESC Heart Failure Heart failure Atrial fibrillation Elderly patients Direct oral anticoagulant Warfarin Anticoagulation |
| title | Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients |
| title_full | Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients |
| title_fullStr | Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients |
| title_full_unstemmed | Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients |
| title_short | Clinical outcomes and anticoagulation therapy in elderly non‐valvular atrial fibrillation and heart failure patients |
| title_sort | clinical outcomes and anticoagulation therapy in elderly non valvular atrial fibrillation and heart failure patients |
| topic | Heart failure Atrial fibrillation Elderly patients Direct oral anticoagulant Warfarin Anticoagulation |
| url | https://doi.org/10.1002/ehf2.14550 |
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