Wen-Han Cheng1, Chern-En Chiang2, Yenn-Jiang Lin1, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Ta-Chuan Tuan1, Jo-Nan Liao1, Fa-Po Chung1, Tzeng-Ji Chen3, Gregory Y H Lip4, Shih-Ann Chen5, Tze-Fan Chao6. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. 2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. 3. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 4. Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 5. Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. 6. Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: eyckeyck@gmail.com.
Abstract
OBJECTIVE: To investigate the influences of non-vitamin K antagonist oral anticoagulants (NOACs) on rates of initiations of oral anticoagulants (OACs) and outcomes among elderly patients with atrial fibrillation (AF). METHODS: From January 1, 2009, to December 31, 2015, 33,539 newly-diagnosed AF patients older than 85 years old who survived more than 180 days after AF diagnosis were studied. Temporal trends regarding OAC initiation rates after incident AF were analyzed. The 1-year risks of ischemic stroke, intracranial hemorrhage, and mortality of incident AF patients diagnosed each year were compared with that of the year 2009. RESULTS: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased from 9.5% to 34.3%, mainly due to the introduction of NOACs (from 0% to 26.2%). Several clinical factors were associated with OACs underuse, including chronic obstructive pulmonary disease, abnormal renal function, anemia, and history of bleeding. Compared with year 2009 (incidence rate, 5.55%/year), the 1-year risk of ischemic stroke after AF diagnosis decreased in the era of NOACs (incidence rate, 4.20%/year; adjusted hazard ratio [aHR], 0.748 in year 2012; 4.39%/year, aHR, 0.789 in 2014; 2.75%/year; aHR, 0.513 in year 2015; all P<.01, except for year 2013, 4.80%/year [P=.07]). Also, the risks of mortality were lower in years 2012 to 2015, while the risk of ICH remained unchanged. CONCLUSION: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased following the introduction of NOACs. A lower risk of ischemic stroke, mortality, and composite adverse events was observed, which was temporally associated with the increasing prescription rates of OACs.
OBJECTIVE: To investigate the influences of non-vitamin K antagonist oral anticoagulants (NOACs) on rates of initiations of oral anticoagulants (OACs) and outcomes among elderly patients with atrial fibrillation (AF). METHODS: From January 1, 2009, to December 31, 2015, 33,539 newly-diagnosed AFpatients older than 85 years old who survived more than 180 days after AF diagnosis were studied. Temporal trends regarding OAC initiation rates after incident AF were analyzed. The 1-year risks of ischemic stroke, intracranial hemorrhage, and mortality of incident AFpatients diagnosed each year were compared with that of the year 2009. RESULTS: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased from 9.5% to 34.3%, mainly due to the introduction of NOACs (from 0% to 26.2%). Several clinical factors were associated with OACs underuse, including chronic obstructive pulmonary disease, abnormal renal function, anemia, and history of bleeding. Compared with year 2009 (incidence rate, 5.55%/year), the 1-year risk of ischemic stroke after AF diagnosis decreased in the era of NOACs (incidence rate, 4.20%/year; adjusted hazard ratio [aHR], 0.748 in year 2012; 4.39%/year, aHR, 0.789 in 2014; 2.75%/year; aHR, 0.513 in year 2015; all P<.01, except for year 2013, 4.80%/year [P=.07]). Also, the risks of mortality were lower in years 2012 to 2015, while the risk of ICH remained unchanged. CONCLUSION: Initiation rates of OACs after AF was newly diagnosed in the elderly significantly increased following the introduction of NOACs. A lower risk of ischemic stroke, mortality, and composite adverse events was observed, which was temporally associated with the increasing prescription rates of OACs.
Authors: U Fan O; Tou Kun Chong; Yulin Wei; Bishow Paudel; Michael C Giudici; Chi Wa Wong; Wai Kit Lei; Jian Chen; Wei Wu; Kan Liu Journal: Int J Cardiol Heart Vasc Date: 2022-03-28
Authors: Alexandros A Polymeris; Kosmas Macha; Maurizio Paciaroni; Duncan Wilson; Masatoshi Koga; Manuel Cappellari; Sabine Schaedelin; Annaelle Zietz; Nils Peters; David J Seiffge; David Haupenthal; Luise Gassmann; Gian Marco De Marchis; Ruihao Wang; Henrik Gensicke; Svenja Stoll; Sebastian Thilemann; Nikolaos S Avramiotis; Bruno Bonetti; Georgios Tsivgoulis; Gareth Ambler; Andrea Alberti; Sohei Yoshimura; Martin M Brown; Masayuki Shiozawa; Gregory Y H Lip; Michele Venti; Monica Acciarresi; Kanta Tanaka; Maria Giulia Mosconi; Masahito Takagi; Rolf H Jäger; Keith Muir; Manabu Inoue; Stefan Schwab; Leo H Bonati; Philippe A Lyrer; Kazunori Toyoda; Valeria Caso; David J Werring; Bernd Kallmünzer; Stefan T Engelter Journal: Ann Neurol Date: 2021-11-29 Impact factor: 11.274