Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry

Q: What are the key findings of this study?

Non-persistence to oral anticoagulation was associated with significantly lower health-related quality of life (EQ-VAS) at 12 months (β = -6.25) and 36 months (β = -5.39) after stroke.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke or transient ischemic attack (TIA) and atrial fibrillation (n=1042). Intervention: Oral anticoagulation persistence vs. Non-persistence to oral anticoagulation. Primary outcome: Health-related quality of life (EQ-VAS score) at 12 months (β = -6.25, 95% CI -10.55 to -1.95, p=0.004).

Q: What does this research mean for the field?

Non-persistence to oral anticoagulation is associated with significantly lower health-related quality of life (EQ-VAS) at 12 and 36 months post-stroke in patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lena Steindorf‐Sabath; Manuel C. Olma; Serdar Tütüncü; Claudia Kunze; Ulrike Grittner; Jil Heege; Joanna Dietzel; Johannes Schurig; Peter U. Heuschmann; Matthias Endres; Karl Georg Hæusler

doi:10.1186/s42466-026-00534-z

September 16, 2026Neurological Research and PracticeOpen Access

Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry

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Key result

OAC non-persistence is linked to ~6-point lower EQ-VAS scores at 12 months post-stroke.

β = -6.25
95% CI -10.55 to -1.95
P=0.004
n=1,042

Figures

Why the study?

Does persistence to oral anticoagulation improve health-related quality of life in stroke survivors with atrial fibrillation?

Key Points

To examine the association of oral anticoagulation (OAC) intake, persistence, and anticoagulant type with health-related quality of life over 36 months in stroke survivors with atrial fibrillation.
Retrospective analysis of the multicenter Berlin Atrial Fibrillation Registry involving 1,042 patients with acute ischemic stroke or transient ischemic attack and atrial fibrillation (927 included after excluding deaths or loss to follow-up within 3 months).
Health-related quality of life was assessed at 3, 12, 24, and 36 months using the EQ-5D-3 L questionnaire, evaluating both the EQ-Index and EQ-VAS.
Multivariable linear models examined the associations of OAC intake, treatment persistence, and drug class (direct oral anticoagulants [DOACs] vs. vitamin K antagonists [VKAs]) with EQ-VAS and EQ-Index scores.
At 12 months, OAC intake was associated with higher EQ-VAS scores (β = 6.70, 95% CI [1.20, 12.20], p = 0.017), but this association was not observed up to 36 months (β = -3.67, 95% CI [-7.72, 0.37], p = 0.075).
Non-persistence to OAC was significantly associated with lower EQ-VAS scores at 12 months (β = -6.25, 95% CI [-10.55, -1.95], p = 0.004) and up to 36 months (β = -5.39, 95% CI [-8.25, -2.54], p < 0.001), while EQ-Index values were not statistically significantly affected.
Non-persistence to DOACs was associated with lower EQ-VAS at 12 months (β = -4.73, 95% CI [-9.03, -0.43], p = 0.031) and 36 months (β = -4.62, 95% CI [-7.54, -1.71], p = 0.002), with no statistically significant quality of life difference observed between patients persistent to DOACs versus VKAs.

Study Design

Type

Cohort (n=1,042)

Multicenter

Yes

Structured PICO

Does persistence to oral anticoagulation improve health-related quality of life in stroke survivors with atrial fibrillation?

P

Population

1,042 patients (mean age 76 years, 48% female) with acute ischemic stroke or TIA and atrial fibrillation, followed for up to 36 months.

E

Exposure

Persistence to oral anticoagulation (OAC), including direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs, specifically phenprocoumon), defined as no interruption of ≥ 7 days.

C

Comparator

Non-persistence to oral anticoagulation (interruption of ≥ 7 days) or comparing DOACs versus VKAs.

O

Outcome

Health-related quality of life (HRQoL) measured by the EQ-5D-3L questionnaire (EQ-Index and EQ-VAS) at 12 and up to 36 months post-stroke/TIA.patient reported

Main Result

Mean Difference: -6.25 (95% CI -10.55–-1.95)

p-value: p=0.004

Long-term persistence to oral anticoagulation is associated with better self-reported health status (EQ-VAS) in stroke survivors with atrial fibrillation, with no significant difference between DOACs and VKAs.

Limitations

Observational nature of the study precludes causal interpretation
Small number of patients receiving VKA limited statistical power
Pragmatic definition of persistence may not fully capture treatment patterns
Potential survivor and attrition bias due to loss to follow-up of severely affected patients
Pre-stroke HRQoL was not available
High standard of care in German cohort may limit generalizability
Inability to adjust for major bleeding events due to low case numbers
Potential survivor and attrition bias due to loss to follow-up over 36 months
Lack of pre-stroke HRQoL data
Pragmatic definition of OAC persistence (7-day interruption) may not capture treatment complexity
Small number of VKA patients limiting statistical power

Implication

Non-persistence to oral anticoagulation was associated with worse quality of life after stroke; leaves open whether persistence interventions benefit atrial fibrillation patients.

Abstract

Background Persistence to oral anticoagulation (OAC) is crucial to prevent recurrent stroke in patients with atrial fibrillation (AF). Little is known about the association of OAC intake, persistence to OAC, and type of OAC with health-related quality of life (HRQoL) in stroke survivors with AF. Methods This retrospective analysis of the multicenter Berlin Atrial Fibrillation Registry included 1,042 patients with acute ischemic stroke or transient ischemic attack (TIA) and AF. HRQoL data were measured at 3,12,24 and 36 months after stroke/TIA using the EQ-5D-3 L questionnaire (including EQ-Index and EQ-VAS). Associations between OAC status, persistence to and type of OAC (direct oral anticoagulants (DOACs) against vitamin K antagonists (VKAs)) at 12 and up to 36 months with HRQoL were examined using multivariable linear models. Results Overall, 842 patients completed the 12-months follow-up and 437 patients the 36-months follow-up. After 12 months, OAC intake was associated with higher EQ-VAS scores (β = 6.70, p = 0.017), although this effect was not observed up to 36 months (ß= -3.67, p = 0.075). Non-persistence to OAC was associated with lower EQ-VAS scores at 12 (ß= -6.25, p = 0.004) and 36 months (ß= -5.39, p < 0.001). No evidenve of a statistically significant difference in HRQoL was found between patients persistent to DOACs and those persistent to VKAs. EQ-Index values were not statistically significantly affected. Conclusion Non-persistence to OAC was associated with reduced EQ-VAS up to 36 months after stroke. Notably, no evidence of a statistically significant difference regarding HRQOL was found between patients persistent on DOAC or VKA. Ensuring long-term persistence to OAC may support HRQoL in stroke survivors with AF.

Discussion

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Cite This Study

Steindorf‐Sabath et al. (2026) conducted a cohort in Acute ischemic stroke or transient ischemic attack (TIA) and atrial fibrillation (n=1,042). Oral anticoagulation persistence vs. Non-persistence to oral anticoagulation was evaluated on Health-related quality of life (EQ-VAS score) at 12 months (β = -6.25, 95% CI -10.55 to -1.95, p=0.004). Non-persistence to oral anticoagulation was associated with significantly lower health-related quality of life (EQ-VAS) at 12 months (β = -6.25) and 36 months (β = -5.39) after stroke.

synapsesocial.com/papers/6aabb7c95f706d05830e7199 https://doi.org/10.1186/s42466-026-00534-z

Topics

Persistent AF management

Atrial fibrillation

Anticoagulation in AF

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Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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