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Direct oral anticoagulation and mortality in moderate to high-risk atrial fibrillation

Ronen Arbel1, Ruslan Sergienko2, Ariel Hammerman3

  • 1Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel.

Heart (British Cardiac Society)
|April 12, 2019
PubMed

Insights

Direct oral anticoagulants (DOAC) significantly reduce mortality in non-valvular atrial fibrillation (NVAF) patients. This study shows DOAC therapy is linked to a lower risk of death compared to no anticoagulation, emphasizing its importance for NVAF survival.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Direct oral anticoagulants (DOAC) are recommended for non-valvular atrial fibrillation (NVAF) patients.
  • Anticoagulation management in NVAF patients remains suboptimal.
  • The impact of withholding DOAC therapy on NVAF patient survival is not well-established.

Purpose of the Study:

  • To compare all-cause mortality rates between NVAF patients treated with DOACs and those receiving no anticoagulation.
  • To evaluate the survival benefit of DOAC therapy in a real-world NVAF cohort.

Main Methods:

  • Retrospective cohort study utilizing an extensive electronic health database.
  • Inclusion of newly diagnosed, anticoagulant-naïve NVAF patients eligible for DOAC therapy (2011-2016).
  • Propensity score matching was used to compare DOAC-treated patients with a similar group receiving no anticoagulation.
  • Primary outcome: all-cause mortality, with follow-up until May 2017.

Main Results:

  • 18,901 eligible patients were identified; 8,298 received DOACs and 10,603 received no anticoagulation.
  • After matching, 5,657 patients in each group were analyzed.
  • DOAC therapy was associated with a significantly lower annual mortality rate (7.6%) compared to no anticoagulation (11.1%).
  • Hazard ratio for all-cause mortality with DOAC therapy was 0.69 (95% CI 0.63-0.75, p<0.001).
  • Benefits of DOAC therapy were consistent across all analyzed subgroups.

Conclusions:

  • DOAC therapy significantly reduces the risk of death in newly diagnosed NVAF patients compared to no oral anticoagulation.
  • These findings reinforce the critical importance of initiating and maintaining DOAC therapy for NVAF patients.
  • The study provides robust evidence supporting the use of DOACs for improving survival in the NVAF population.
Abstract

Keywords:
atrial fibrillation

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