Key result
Among 3,680 OAC-treated AF patients, 62.8% received NOACs and 37.2% received VKAs, with nonpermanent AF (OR 1.61; 95% CI 1.34-1.93) and age being independent predictors of NOAC use.
Why the study?
Recent significant changes have occurred in stroke prophylaxis for AF, with NOACs increasingly used, prompting an evaluation of recommended stroke prophylaxis and predictors of NOAC selection.
What are the trends and predictors of NOAC use for stroke prophylaxis in hospitalized patients with atrial fibrillation?
Observational (n=4,027)
No
What are the trends and predictors of NOAC use for stroke prophylaxis in hospitalized patients with atrial fibrillation?
Odds Ratio: 1.61 (95% CI 1.34–1.93)
Absolute Event Rate: 62.8% vs 37.2%
p-value: p=<0.001
The study demonstrates an increasing trend in NOAC use for stroke prophylaxis in AF patients between 2014 and 2018, driven by factors such as age, prior thromboembolism, nonpermanent AF, and preserved renal function.
Rising NOAC use in AF supports evolving real-world patterns; leaves predictors' impact on outcomes open for confirmation.
In recent years, significant changes in stroke prophylaxis in patients with atrial fibrillation (AF) have been observed. Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used in the prevention of thromboembolic complications in patients with AF. The aim of the study was to evaluate recommended stroke prophylaxis in patients with AF and to identify predictors of using NOACs in patients treated with anticoagulant therapy. The present study was a retrospective, observational, single-center study which included consecutively hospitalized patients in the reference cardiology center from January 2014 to December 2018. In the study group of 4027 patients with AF, to prevent thromboembolic complications, OACs were used in 3680 patients (91.4%), an antiplatelet drug(s) was used in 124 patients (3.1%), and 223 patients (5.5%) did not undergo any thromboembolic event prevention. In the group of 3680 patients treated with OACs, 2311 patients (62.8%) received NOACs and 1639 patients (37.2%), VKAs. Independent predictors of the use of NOACs were age (OR, 1.02; 95% CI, 1.01–1.03; <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo><</a:mo> <a:mn>0.001</a:mn> </a:math> ), a previous thromboembolic event (OR, 1.29; 95% CI, 1.01–1.65; <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.04</c:mn> </c:math> ), nonpermanent AF (OR, 1.61; 95% CI, 1.34–1.93; <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo><</e:mo> <e:mn>0.001</e:mn> </e:math> ), and eGFR (OR, 1.22; 95% CI, 1.02–1.46; <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.03</g:mn> </g:math> ). Between 2014 and 2018, an increase of patients treated with OACs, mainly with NOACs, was observed. Age, past thromboembolic complications, nonpermanent AF, and preserved renal function determined the choice of NOACs.
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Bielecka et al. (2021) conducted an observational in atrial fibrillation (n=4,027). NOACs vs. VKAs was evaluated on Independent predictors of NOAC use (e.g., nonpermanent AF) (OR 1.61, 95% CI 1.34-1.93, p=<0.001). Among 3,680 OAC-treated AF patients, 62.8% received NOACs and 37.2% received VKAs, with nonpermanent AF (OR 1.61; 95% CI 1.34-1.93) and age being independent predictors of NOAC use.
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