Early And Long-term Outcomes After DOAC Initiation In Hospitalized Patients With Newly Diagnosed Atrial Fibrillation

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• New-onset atrial fibrillation (AF) is prevalent in hospitalized patients, increasing risks of stroke and mortality.
• Anticoagulation decisions involve balancing bleeding risks during recovery against long-term stroke prevention.
• Limited data exist on initiating direct oral anticoagulants (DOACs) at discharge for newly diagnosed AF.

Purpose of the Study:

• To evaluate the association between DOAC initiation at discharge and clinical outcomes in patients with newly diagnosed AF.
• To compare major adverse cardiovascular events (MACE) and net adverse clinical events (NACE) between DOAC and non-DOAC groups.
• To assess early (30-day) and long-term (3-year) event rates following hospital discharge.

Main Methods:

• Retrospective cohort study of adults with newly diagnosed AF between July 2020 and June 2024.
• Comparison of patients discharged on DOAC therapy versus those not receiving DOACs.
• Utilized Cox proportional hazards models and landmark cumulative incidence analyses to assess outcomes.

Main Results:

• Among 16,641 patients, 43.2% were discharged on a DOAC.
• DOAC use was associated with a significantly lower risk of 3-year MACE (HR 0.61) and NACE (HR 0.64).
• Landmark analyses confirmed consistent reductions in MACE and NACE at both 30 days and 3 years for DOAC recipients.

Conclusions:

• DOAC initiation at hospital discharge for newly diagnosed AF is linked to reduced early and long-term ischemic risks.
• Lower rates of MACE and NACE were observed in patients discharged on DOACs.
• Individualized decision-making regarding anticoagulation during acute hospitalization is crucial.