AIMS: To determine exposure to warfarin and the associated outcomes in a population of older patients with non-valvular atrial fibrillation (NVAF). METHODS: Cohort study of patients aged 65-89 years admitted to hospital July 2003-December 2008 with newly-diagnosed or pre-existing AF. Outcomes at three years among one-year survivors post-index admission (landmark date) were all-cause mortality, stroke/systemic thromboembolism (stroke/TE) and bleeding. Multivariate Cox models were used to identify factors associated with each outcome. RESULTS: AF was the principal diagnosis for 27.5% of 17,336 index AF admissions. Of 14,634 (84.4%) patients alive at one-year 1,384 (9.5%) died in the following year. Vascular disease (42%) was the most frequent cause of death.Warfarin use, prior to the index admission and/or the 1-year landmark, did not exceed 40%.Compared to non-exposure or discontinuation at the index admission, initiation or persistence with warfarin prior to the landmark date was associated with reduced risk for all-cause mortality, a statistically non-significant reduction in risk for stroke/TE, and an increased risk for bleeding. Higher CHA2DS2-VASc scores were associated with increased risk for each outcome. CONCLUSIONS: In a population-based cohort of hospitalised NVAF patients, the initiation and persistent use of warfarin was associated with lower all-cause mortality risk to three years, although reduction in risk for stroke/TE did not reach statistical significance. The apparent under-use of warfarin in this older, high-risk cohort reinforces the opportunity for further reduction in stroke/TE with the uptake of non-vitamin K oral anti-coagulants (NOACs) among those not prescribed, or not persistent with, warfarin.
AIMS: To determine exposure to warfarin and the associated outcomes in a population of older patients with non-valvular atrial fibrillation (NVAF). METHODS: Cohort study of patients aged 65-89 years admitted to hospital July 2003-December 2008 with newly-diagnosed or pre-existing AF. Outcomes at three years among one-year survivors post-index admission (landmark date) were all-cause mortality, stroke/systemic thromboembolism (stroke/TE) and bleeding. Multivariate Cox models were used to identify factors associated with each outcome. RESULTS: AF was the principal diagnosis for 27.5% of 17,336 index AF admissions. Of 14,634 (84.4%) patients alive at one-year 1,384 (9.5%) died in the following year. Vascular disease (42%) was the most frequent cause of death.Warfarin use, prior to the index admission and/or the 1-year landmark, did not exceed 40%.Compared to non-exposure or discontinuation at the index admission, initiation or persistence with warfarin prior to the landmark date was associated with reduced risk for all-cause mortality, a statistically non-significant reduction in risk for stroke/TE, and an increased risk for bleeding. Higher CHA2DS2-VASc scores were associated with increased risk for each outcome. CONCLUSIONS: In a population-based cohort of hospitalised NVAF patients, the initiation and persistent use of warfarin was associated with lower all-cause mortality risk to three years, although reduction in risk for stroke/TE did not reach statistical significance. The apparent under-use of warfarin in this older, high-risk cohort reinforces the opportunity for further reduction in stroke/TE with the uptake of non-vitamin K oral anti-coagulants (NOACs) among those not prescribed, or not persistent with, warfarin.
Authors: Craig T January; L Samuel Wann; Hugh Calkins; Lin Y Chen; Joaquin E Cigarroa; Joseph C Cleveland; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Karen L Furie; Paul A Heidenreich; Katherine T Murray; Julie B Shea; Cynthia M Tracy; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2019-01-28 Impact factor: 24.094
Authors: Xiaojuan Mi; Bradley G Hammill; Lesley H Curtis; Edward Chia-Cheng Lai; Soko Setoguchi Journal: Stat Med Date: 2016-06-27 Impact factor: 2.373
Authors: L C Lopes; F A Spencer; I Neumann; M Ventresca; S Ebrahim; Q Zhou; N Bhatnaga; S Schulman; J Eikelboom; G Guyatt Journal: Clin Pharmacol Ther Date: 2013-05-13 Impact factor: 6.875
Authors: Jeff S Healey; Jonas Oldgren; Michael Ezekowitz; Jun Zhu; Prem Pais; Jia Wang; Patrick Commerford; Petr Jansky; Alvaro Avezum; Alben Sigamani; Albertino Damasceno; Paul Reilly; Alex Grinvalds; Juliet Nakamya; Akinyemi Aje; Wael Almahmeed; Andrew Moriarty; Lars Wallentin; Salim Yusuf; Stuart J Connolly Journal: Lancet Date: 2016-08-08 Impact factor: 79.321