Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study
<p><strong>Background</strong><br> We investigated differences in risk of stroke, with all-cause mortality as a competing risk, in people newly diagnosed with atrial fibrillation (AF) who were commenced on either direct oral anticoagulants (DOACs) or warfarin treatment.<br...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Public Library of Science
2022
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| _version_ | 1826310471009959936 |
|---|---|
| author | de Lusignan, S Hobbs, FDR Liyanage, H Sherlock, J Ferreira, F Tripathy, M Heiss, C Feher, M Joy, MP |
| author_facet | de Lusignan, S Hobbs, FDR Liyanage, H Sherlock, J Ferreira, F Tripathy, M Heiss, C Feher, M Joy, MP |
| author_sort | de Lusignan, S |
| collection | OXFORD |
| description | <p><strong>Background</strong><br>
We investigated differences in risk of stroke, with all-cause mortality as a competing risk, in people newly diagnosed with atrial fibrillation (AF) who were commenced on either direct oral anticoagulants (DOACs) or warfarin treatment.<br><br>
<strong>Methods and results</strong><br>
We conducted a retrospective cohort study of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database (a network of 500 English general practices). We compared long term exposure to DOAC (n = 5,168) and warfarin (n = 7,451) in new cases of AF not previously treated with oral anticoagulants. Analyses included: survival analysis, estimating cause specific hazard ratios (CSHR), Fine-Gray analysis for factors affecting cumulative incidence of events occurring over time and a cumulative risk regression with time varying effects.We found no difference in CSHR between stroke 1.08 (0.72–1.63, p = 0.69) and all-cause mortality 0.93 (0.81–1.08, p = 0.37), or between the anticoagulant groups. Fine-Gray analysis produced similar results 1.07 (0.71–1.6 p = 0.75) for stroke and 0.93 (0.8–1.07, p = 0.3) mortality. The cumulative risk of mortality with DOAC was significantly elevated in early follow-up (67 days), with cumulative risk decreasing until 1,537 days and all-cause mortality risk significantly decreased coefficient estimate:: -0.23 (-0.38–0.01, p = 0.001); which persisted over seven years of follow-up.<br><br>
<strong>Conclusions</strong><br>
In this large, contemporary, real world primary care study with longer follow-up, we found no overall difference in the hazard of stroke between warfarin and DOAC treatment for AF. However, there was a significant time-varying effect between anti-coagulant regimen on all-cause mortality, with DOACs showing better survival. This is a key methodological observation for future follow-up studies, and reassuring for patients and health care professionals for longer duration of therapy.</p> |
| first_indexed | 2024-03-07T07:52:25Z |
| format | Journal article |
| id | oxford-uuid:0f77f395-84b0-4ebd-9fda-91dd5b38914c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:52:25Z |
| publishDate | 2022 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:0f77f395-84b0-4ebd-9fda-91dd5b38914c2023-07-27T12:31:25ZLong term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0f77f395-84b0-4ebd-9fda-91dd5b38914cEnglishSymplectic ElementsPublic Library of Science 2022de Lusignan, SHobbs, FDRLiyanage, HSherlock, JFerreira, FTripathy, MHeiss, CFeher, MJoy, MP<p><strong>Background</strong><br> We investigated differences in risk of stroke, with all-cause mortality as a competing risk, in people newly diagnosed with atrial fibrillation (AF) who were commenced on either direct oral anticoagulants (DOACs) or warfarin treatment.<br><br> <strong>Methods and results</strong><br> We conducted a retrospective cohort study of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database (a network of 500 English general practices). We compared long term exposure to DOAC (n = 5,168) and warfarin (n = 7,451) in new cases of AF not previously treated with oral anticoagulants. Analyses included: survival analysis, estimating cause specific hazard ratios (CSHR), Fine-Gray analysis for factors affecting cumulative incidence of events occurring over time and a cumulative risk regression with time varying effects.We found no difference in CSHR between stroke 1.08 (0.72–1.63, p = 0.69) and all-cause mortality 0.93 (0.81–1.08, p = 0.37), or between the anticoagulant groups. Fine-Gray analysis produced similar results 1.07 (0.71–1.6 p = 0.75) for stroke and 0.93 (0.8–1.07, p = 0.3) mortality. The cumulative risk of mortality with DOAC was significantly elevated in early follow-up (67 days), with cumulative risk decreasing until 1,537 days and all-cause mortality risk significantly decreased coefficient estimate:: -0.23 (-0.38–0.01, p = 0.001); which persisted over seven years of follow-up.<br><br> <strong>Conclusions</strong><br> In this large, contemporary, real world primary care study with longer follow-up, we found no overall difference in the hazard of stroke between warfarin and DOAC treatment for AF. However, there was a significant time-varying effect between anti-coagulant regimen on all-cause mortality, with DOACs showing better survival. This is a key methodological observation for future follow-up studies, and reassuring for patients and health care professionals for longer duration of therapy.</p> |
| spellingShingle | de Lusignan, S Hobbs, FDR Liyanage, H Sherlock, J Ferreira, F Tripathy, M Heiss, C Feher, M Joy, MP Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title | Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title_full | Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title_fullStr | Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title_full_unstemmed | Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title_short | Long term follow up of direct oral anticoagulants and warfarin therapy on stroke, with all-cause mortality as a competing risk, in people with atrial fibrillation: sentinel network database study |
| title_sort | long term follow up of direct oral anticoagulants and warfarin therapy on stroke with all cause mortality as a competing risk in people with atrial fibrillation sentinel network database study |
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