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November 10, 2023Journal of the American Heart AssociationOpen Access

Clinical Outcomes in Patients With Atrial Fibrillation Treated With Non–Vitamin K Oral Anticoagulants Across Varying Body Mass Index

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Why the study?

Data are conflicting regarding outcomes across varying body mass index (BMI) in patients with atrial fibrillation treated with non-vitamin K oral anticoagulants.

Does varying body mass index affect mortality, ischemic stroke/systemic embolism, and major bleeding in patients with atrial fibrillation treated with non-vitamin K oral anticoagulants?

Population

26 047 non-vitamin K oral anticoagulant-treated patients with atrial fibrillation

Comparison

Outcomes compared across continuous BMI and BMI categories from underweight to obesity class III

Design

Registry-based observational cohort study

Key result

In NOAC-treated patients with atrial fibrillation, both underweight (HR 1.77; 95% CI 1.57-1.99) and obesity class III (HR 1.67; 95% CI 1.40-1.99) were associated with increased mortality.

Authors

AHAstrid Fritz HanssonKEKarin Jensevik ErikssonCCChristina Christersson

Discussion

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Overview

May support BMI-stratified monitoring in NOAC-treated AF without altering therapy; leaves open causal mechanisms and prospective validation.

Study Design

Type

Cohort (n=26,047)

Structured PICO

Does varying body mass index affect mortality, ischemic stroke/systemic embolism, and major bleeding in patients with atrial fibrillation treated with non-vitamin K oral anticoagulants?

P
Population
26,047 patients with atrial fibrillation treated with non-vitamin K oral anticoagulants from the Swedish oral anticoagulation registry
I
Intervention
Varying Body Mass Index (BMI) categories (underweight, normal weight, preobesity, obesity class I to III)
C
Comparator
Normal weight (18.5 to <25 kg/m2) or continuous BMI comparison
O
Outcome
Mortality, ischemic stroke/systemic embolism, and major bleedinghard clinical

Main Result

Effect estimate: HR 1.77 (95% CI 1.57-1.99)

In atrial fibrillation patients treated with non-vitamin K oral anticoagulants, there is a U-shaped relationship between BMI and both mortality and major bleeding, with the highest risks observed in underweight and class III obesity patients.

Cite This Study

Hansson et al. (2023) conducted a cohort in Atrial fibrillation (n=26,047). Varying Body Mass Index (BMI) vs. Normal weight (18.5 to <25 kg/m2) was evaluated on Mortality, ischemic stroke/systemic embolism, and major bleeding (HR 1.77, 95% CI 1.57-1.99). In NOAC-treated patients with atrial fibrillation, both underweight (HR 1.77; 95% CI 1.57-1.99) and obesity class III (HR 1.67; 95% CI 1.40-1.99) were associated with increased mortality.

synapsesocial.com/papers/6a1b5929dd28c50f8442aa1ahttps://doi.org/10.1161/jaha.123.030829
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