Patient Outcomes in Very Elderly Patients With Non-Valvular Atrial Fibrillation　- ANAFIE Registry

Area of Science:

• Cardiology
• Geriatrics
• Pharmacology

Background:

• The All Nippon Atrial Fibrillation In the Elderly Registry analyzed real-world data from over 30,000 Japanese patients (≥75 years) with non-valvular atrial fibrillation (NVAF).
• The cohort included over 2,000 nonagenarians, providing insights into outcomes in the oldest elderly population.

Purpose of the Study:

• To investigate the outcomes of elderly patients with NVAF based on age groups and the type of oral anticoagulant (OAC) used.
• To compare the effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin in different age strata.

Main Methods:

• A prospective, multicenter, observational cohort study with a 2-year follow-up.
• Evaluation of incidences of stroke/systemic embolic events (SEE), major bleeding, intracranial hemorrhage (ICH), cardiovascular death, all-cause death, and major adverse cardiovascular or neurological events (MACNE).
• Analysis stratified by age groups (≥75 years) and OAC type (DOACs vs. warfarin).

Main Results:

• Incidence rates of adverse events significantly increased with age, plateauing for stroke/SEE, major bleeding, and ICH in patients aged ≥90 years.
• DOACs showed numerically lower event incidences than warfarin across most age groups and endpoints, except for major bleeding in nonagenarians.
• DOACs were significantly associated with reduced risks of stroke/SEE, major bleeding, and ICH in the 80-85 years group, and reduced mortality in the 75-80 years group.

Conclusions:

• Direct oral anticoagulants (DOACs) offer potential benefits for stroke prevention in elderly NVAF patients compared to warfarin.
• Limitations in reducing major bleeding were observed in patients aged ≥90 years, suggesting a potential role for very-low-dose DOACs in this population.
• A history of major bleeding was identified as a risk factor for all-cause death in the ≥90 years subgroup.