Key result
In patients with atrial fibrillation and recent biological valvular intervention, 48.8% with a history of AF and 46.3% with new-onset AF were not dispensed any oral anticoagulant at discharge.
Why the study?
To describe the prevalence of AF, OAC use, and changes in antithrombotic treatment patterns during follow-up after bioprosthetic valve intervention or valvuloplasty.
What is the prevalence of AF and the pattern of oral anticoagulant use in patients after bioprosthetic valvular intervention or valvuloplasty?
Observational (n=7,362)
Yes
What is the prevalence of AF and the pattern of oral anticoagulant use in patients after bioprosthetic valvular intervention or valvuloplasty?
There is significant undertreatment with oral anticoagulants in patients with atrial fibrillation following bioprosthetic valvular intervention or valvuloplasty, despite high stroke risk scores.
AF common in registry with frequent OAC omission at discharge; leaves open optimal strategies pending prospective data.
AIMS: To describe the prevalence of atrial fibrillation (AF), use of oral anticoagulants (OAC) and change in antithrombotic treatment patterns during follow-up after valve intervention with a biological prosthesis or valvuloplasty. METHODS AND RESULTS: All patients with history of AF or new-onset AF discharged alive after valvular intervention (biological prosthesis or valvuloplasty) between 2010-2016 in Sweden were included (n = 7,362). Information about comorbidities was collected from national patient registers. Exposure to OAC was based on pharmacy dispensation data. In total 4,800 (65.2%) patients had a history of AF, and 2,562 (34.8%) patients developed new-onset AF, with 999 (39.0%) developing new-onset AF within 3 months after intervention. The proportion of patients with biological valve prosthesis was higher in patients with new-onset AF compared to history of AF (p<0.001). CHA2DS2-VASc score ≥2 was observed in 83.1% and 75.5% patients with history of AF and new-onset AF, respectively. Warfarin was more frequently dispensed than NOAC at discharge in patients with history of AF (43.9% vs 7.3%), and in patients with new-onset AF (36.6% vs 17.1%). Almost half of the AF population was not dispensed on any OAC at discharge (48.8% in patients with history of AF and 46.3% in patients with new-onset AF). CONCLUSION: In this real world study of patients with AF and recent valvular intervention, risk of new-onset AF after valvular intervention is high emphasizing need for frequent rhythm monitoring after intervention. A considerable undertreatment with OAC was observed despite being indicated for the majority of the patients. Warfarin was the OAC most frequently dispensed.
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Christersson et al. (2022) conducted an observational in Atrial fibrillation and recent biological valvular intervention or valvuloplasty (n=7,362). Oral anticoagulants (Warfarin or NOAC) vs. No oral anticoagulant was evaluated on Dispensation of oral anticoagulants at discharge or diagnosis. In patients with atrial fibrillation and recent biological valvular intervention, 48.8% with a history of AF and 46.3% with new-onset AF were not dispensed any oral anticoagulant at discharge.
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