Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study
Abstract 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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-022-01688-1 |
| _version_ | 1797958846243667968 |
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| author | Shu-Man Lin Peter Pin-Sung Liu Yu-Kang Tu Edward Chia-Cheng Lai Jih-I Yeh Jin-Yi Hsu Kashif M. Munir Carol Chiung-Hui Peng Huei-Kai Huang Ching-Hui Loh |
| author_facet | Shu-Man Lin Peter Pin-Sung Liu Yu-Kang Tu Edward Chia-Cheng Lai Jih-I Yeh Jin-Yi Hsu Kashif M. Munir Carol Chiung-Hui Peng Huei-Kai Huang Ching-Hui Loh |
| author_sort | Shu-Man Lin |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T00:25:42Z |
| format | Article |
| id | doaj.art-f3ba41cda7254767bb28a061ebf9f42b |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-11T00:25:42Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-f3ba41cda7254767bb28a061ebf9f42b2023-01-08T12:04:12ZengBMCCardiovascular Diabetology1475-28402023-01-0122111110.1186/s12933-022-01688-1Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort studyShu-Man Lin0Peter Pin-Sung Liu1Yu-Kang Tu2Edward Chia-Cheng Lai3Jih-I Yeh4Jin-Yi Hsu5Kashif M. Munir6Carol Chiung-Hui Peng7Huei-Kai Huang8Ching-Hui Loh9Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationCenter for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationInstitute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan UniversitySchool of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversitySchool of Medicine, Tzu Chi UniversitySchool of Medicine, Tzu Chi UniversityDivision of Endocrinology, Diabetes and Nutrition, University of Maryland School of MedicineSection of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of MedicineSchool of Medicine, Tzu Chi UniversitySchool of Medicine, Tzu Chi UniversityAbstract 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.https://doi.org/10.1186/s12933-022-01688-1Oral anticoagulantHeart failureAtrial fibrillationDiabetes mellitusElderly |
| spellingShingle | Shu-Man Lin Peter Pin-Sung Liu Yu-Kang Tu Edward Chia-Cheng Lai Jih-I Yeh Jin-Yi Hsu Kashif M. Munir Carol Chiung-Hui Peng Huei-Kai Huang Ching-Hui Loh Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study Cardiovascular Diabetology Oral anticoagulant Heart failure Atrial fibrillation Diabetes mellitus Elderly |
| title | Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study |
| title_full | Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study |
| title_fullStr | Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study |
| title_full_unstemmed | Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study |
| title_short | Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study |
| title_sort | risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants a nationwide cohort study |
| topic | Oral anticoagulant Heart failure Atrial fibrillation Diabetes mellitus Elderly |
| url | https://doi.org/10.1186/s12933-022-01688-1 |
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