Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study
Background: Data on non-vitamin K antagonist oral anticoagulant (NOAC) use in patients with atrial fibrillation (AF) and a history of falls are limited. Therefore, we investigated the impact of a history of falls on AF-related outcomes, and the benefit-risk profiles of NOACs in patients with a histo...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906723000544 |
| _version_ | 1797752998406914048 |
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| author | Maxim Grymonprez Mirko Petrovic Tine L. De Backer Stephane Steurbaut Lies Lahousse |
| author_facet | Maxim Grymonprez Mirko Petrovic Tine L. De Backer Stephane Steurbaut Lies Lahousse |
| author_sort | Maxim Grymonprez |
| collection | DOAJ |
| description | Background: Data on non-vitamin K antagonist oral anticoagulant (NOAC) use in patients with atrial fibrillation (AF) and a history of falls are limited. Therefore, we investigated the impact of a history of falls on AF-related outcomes, and the benefit-risk profiles of NOACs in patients with a history of falls. Methods: Using Belgian nationwide data, AF patients initiating anticoagulation between 2013 and 2019 were included. Previous falls that occurred ≤ 1 year before anticoagulant initiation were identified. Results: Among 254,478 AF patients, 18,947 (7.4%) subjects had a history of falls, which was associated with higher risks of all-cause mortality (adjusted hazard ratio (aHR) 1.11, 95%CI (1.06–1.15)), major bleeding (aHR 1.07, 95%CI (1.01–1.14)), intracranial bleeding (aHR 1.30, 95%CI (1.16–1.47)) and new falls (aHR 1.63, 95%CI (1.55–1.71)), but not with thromboembolism. Among subjects with a history of falls, NOACs were associated with lower risks of stroke or systemic embolism (aHR 0.70, 95%CI (0.57–0.87)), ischemic stroke (aHR 0.59, 95%CI (0.45–0.77)) and all-cause mortality (aHR 0.83, 95%CI (0.75–0.92)) compared to vitamin K antagonists (VKAs), while major, intracranial, and gastrointestinal bleeding risks were not significantly different. Major bleeding risks were significantly lower with apixaban (aHR 0.77, 95%CI (0.63–0.94)), but similar with other NOACs compared to VKAs. Apixaban was associated with lower major bleeding risks compared to dabigatran (aHR 0.78, 95%CI (0.62–0.98)), rivaroxaban (aHR 0.78, 95%CI (0.68–0.91)) and edoxaban (aHR 0.74, 95%CI (0.59–0.92)), but mortality risks were higher compared to dabigatran and edoxaban. Conclusions: A history of falls was an independent predictor of bleeding and death. NOACs had better benefit-risk profiles than VKAs in patients with a history of falls, especially apixaban. |
| first_indexed | 2024-03-12T17:11:32Z |
| format | Article |
| id | doaj.art-aa5f9470e78047cb835bed3c5400230f |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-03-12T17:11:32Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-aa5f9470e78047cb835bed3c5400230f2023-08-06T04:37:48ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672023-08-0147101223Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort studyMaxim Grymonprez0Mirko Petrovic1Tine L. De Backer2Stephane Steurbaut3Lies Lahousse4Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, BelgiumDepartment of Geriatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, BelgiumDepartment of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, BelgiumCentre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumDepartment of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands; Corresponding author at: Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.Background: Data on non-vitamin K antagonist oral anticoagulant (NOAC) use in patients with atrial fibrillation (AF) and a history of falls are limited. Therefore, we investigated the impact of a history of falls on AF-related outcomes, and the benefit-risk profiles of NOACs in patients with a history of falls. Methods: Using Belgian nationwide data, AF patients initiating anticoagulation between 2013 and 2019 were included. Previous falls that occurred ≤ 1 year before anticoagulant initiation were identified. Results: Among 254,478 AF patients, 18,947 (7.4%) subjects had a history of falls, which was associated with higher risks of all-cause mortality (adjusted hazard ratio (aHR) 1.11, 95%CI (1.06–1.15)), major bleeding (aHR 1.07, 95%CI (1.01–1.14)), intracranial bleeding (aHR 1.30, 95%CI (1.16–1.47)) and new falls (aHR 1.63, 95%CI (1.55–1.71)), but not with thromboembolism. Among subjects with a history of falls, NOACs were associated with lower risks of stroke or systemic embolism (aHR 0.70, 95%CI (0.57–0.87)), ischemic stroke (aHR 0.59, 95%CI (0.45–0.77)) and all-cause mortality (aHR 0.83, 95%CI (0.75–0.92)) compared to vitamin K antagonists (VKAs), while major, intracranial, and gastrointestinal bleeding risks were not significantly different. Major bleeding risks were significantly lower with apixaban (aHR 0.77, 95%CI (0.63–0.94)), but similar with other NOACs compared to VKAs. Apixaban was associated with lower major bleeding risks compared to dabigatran (aHR 0.78, 95%CI (0.62–0.98)), rivaroxaban (aHR 0.78, 95%CI (0.68–0.91)) and edoxaban (aHR 0.74, 95%CI (0.59–0.92)), but mortality risks were higher compared to dabigatran and edoxaban. Conclusions: A history of falls was an independent predictor of bleeding and death. NOACs had better benefit-risk profiles than VKAs in patients with a history of falls, especially apixaban.http://www.sciencedirect.com/science/article/pii/S2352906723000544Atrial fibrillationFallAnticoagulationThromboembolismBleedingMortality |
| spellingShingle | Maxim Grymonprez Mirko Petrovic Tine L. De Backer Stephane Steurbaut Lies Lahousse Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study International Journal of Cardiology: Heart & Vasculature Atrial fibrillation Fall Anticoagulation Thromboembolism Bleeding Mortality |
| title | Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study |
| title_full | Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study |
| title_fullStr | Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study |
| title_full_unstemmed | Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study |
| title_short | Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study |
| title_sort | clinical outcomes in patients with atrial fibrillation and a history of falls using non vitamin k antagonist oral anticoagulants a nationwide cohort study |
| topic | Atrial fibrillation Fall Anticoagulation Thromboembolism Bleeding Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2352906723000544 |
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