Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Group
2.2. Assessed Parameters
2.3. Assessment of the Thromboembolic Risk and Bleeding Risk
2.4. Prophylaxis of Thromboembolic Complications
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Study Group
3.2. Predictors of the Use of Individual NOACs
4. Discussion
5. Study Strengths and Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Clinical Characteristic | All NOAC n = 1443 | Apixaban n = 329 | Dabigatran n = 618 | Rivaroxaban n = 496 | p |
---|---|---|---|---|---|
Age | |||||
Mean (SD), years | 82.3 (5) | 83.8 (5.3) | 81.7 (4.8) | 81.9 (4.8) | <0.001 |
Median (IQR) | 82 (8) | 84 (8) a | 81 (7) b | 82 (7) b | |
Gender | |||||
Female, n (%) | 836 (57.9) | 193 (58.7) | 338 (54.7) | 305 (61.5) | 0.070 |
Type of atrial fibrillation n(%) | |||||
Paroxysmal | 657 (45.5) | 148 (45) | 295 (47.7) | 214 (43.1) | 0.303 |
Persistent | 154 (10.7) | 35 (10.6) | 57 (9.2) | 62 (12.5) | 0.212 |
Permanent | 632 (43.8) | 146 (44.4) | 266 (43) | 220 (44.4) | 0.882 |
Non-permanent | 811 (56.2) | 183 (55.6) | 352 (57) | 276 (55.6) | 0.882 |
Medical history n(%) | |||||
Hypertension | 1174 (81.3) | 259 (78.7) ab | 524 (84.8) b | 391 (78.8) a | 0.015 |
Heart failure | 992 (68.7) | 237 (72) | 419 (67.8) | 336 (67.7) | 0.342 |
Vascular disease | 693 (48) | 164 (49.8) | 301 (48.7) | 228 (46) | 0.498 |
Previous myocardial infarction | 351 (24.3) | 93 (28.3) | 149 (24.1) | 109 (22) | 0.118 |
PAD | 159 (11) | 45 (13.7) | 71 (11.5) | 43 (8.7) | 0.071 |
Previous stroke/TIA/peripheral embolism | 244 (16.9) | 55 (16.7) | 111 (18) | 78 (15.7) | 0.610 |
Diabetes mellitus | 439 (30.4) | 106 (32.2) | 183 (29.6) | 150 (30.2) | 0.704 |
Any previous bleeding | 59 (4.1) | 27 (8.2) a | 20 (3.2) b | 12 (2.4) b | <0.001 |
Ulcer | 36 (2.5) | 4 (1.2) | 15 (2.4) | 17 (3.4) | 0.136 |
Malignancy | 81 (5.6) | 22 (6.7) | 31 (5) | 28 (5.6) | 0.568 |
Thromboembolic risk | |||||
CHA2DS2-VASC score | |||||
Mean (SD) | 5.2 (1.4) | 5.3 (1.5) | 5.2 (1.4) | 5.2 (1.4) | 0.644 |
Bleeding risk | |||||
HAS-BLED score | |||||
Mean (SD) | 2.2 (0.8) | 2.2 (0.7) | 2.3 (0.7) | 2.2 (0.8) | 0.026 |
Median (IQR) | 2 (1) | 2 (1) a | 2 (1) b | 2 (1) ab | |
≥3, n (%) | 466 (32.3) | 88 (26.7) a | 214 (34.6) b | 164 (33.1) ab | 0.043 |
Reason for hospitalisation, n(%) | |||||
Electrical cardioversion | 96 (6.6) | 18 (5.5) | 42 (6.8) | 36 (7.3) | 0.591 |
Planned coronarography/PCI/ACS | 115 (8) | 31 (9.4) | 44 (7.1) | 40 (8.1) | 0.458 |
Heart failure | 414 (28.7) | 120 (36.5) a | 171 (27.7) b | 123 (24.8) b | 0.001 |
Ablation | 17 (1.2) | 2 (0.6) | 5 (0.8) | 10 (2) | 0.122 |
CIED | 301 (20.8) | 51 (15.5) a | 133 (21.5) ab | 116 (23.4) b | 0.017 |
AF attack | 157 (10.9) | 32 (9.7) | 78 (12.6) | 47 (9.5) | 0.183 |
Other | 343 (23.8) | 75 (22.8) | 145 (23.5) | 123 (24.8) | 0.781 |
Laboratory tests | |||||
Haemoglobin | |||||
Mean (SD), g/dl | 12.9 (3.3) n = 1418 | 12.5 (1.7) n = 319 | 13.1 (4.7) n = 609 | 12.8 (1.6) n = 490 | <0.001 |
Median (IQR) | 12.8 (2.1) | 12.4 (2.2) a | 12.9 (2.1) b | 12.9 (2) b | |
Platelet | |||||
Mean (SD), K/uL | 209.9 (75.3) n = 1410 | 207.6 (79.5) n = 318 | 207.2 (72.6) n = 604 | 214.6 (75.7) n = 488 | 0.113 |
Median (IQR) | 198 (78) | 197.5 (93.8) | 194 (72) | 202.5 (76) | |
eGFR | |||||
Mean (SD), mL/min/1.73 m2 | 49.9 (14.8) n = 1438 | 45.8 (17.3) n = 327 | 52.3 (12.6) n = 616 | 49.7 (14.9) n = 495 | <0.001 |
Median (IQR) | 49.3 (19.3) | 43 (24.8) a | 51.2 (17.2) b | 49.2 (19.6) c | |
<60 mL/min/1.73 m2, n (%) | 1107 (77) n = 1438 | 264 (80.7) N = 327 | 458 (74.4) n = 616 | 385 (77.8) n = 495 | 0.088 |
Echocardiographic findings | |||||
Ejection fraction, mm | |||||
Mean (SD) | 49.2 (20.3) n = 1185 | 47 (12.5) n = 269 | 50.3 (27.4) n = 516 | 49.4 (12) n = 400 | 0.021 |
Median (IQR) | 50 (18) | 50 (17) a | 52 (17) b | 50 (15) ab | |
Left ventricular systolic diameter, mm | |||||
Mean (SD) | 36.3 (9.5) n = 1160 | 36.1 (9.2) n = 263 | 37 (10) n = 509 | 35.7 (8.8) n = 388 | 0.352 |
Median (IQR) | 35 (11) | 35 (12) | 35 (12) | 34 (10) | |
Left ventricular diastolic diameter, mm | |||||
Mean (SD) | 50.2 (8) n = 1168 | 49.2 (8.5) n = 268 | 50.9 (8) n = 511 | 49.9 (7.6) n = 389 | 0.016 |
Median (IQR) | 49 (10) | 48.5 (12) a | 50 (11) b | 49 (10) ab | |
Reduced dose, n (%) | 920 (63.7) | 137 (41.6) a | 487 (78.8) b | 296 (59.7) c | <0.001 |
Antiplatelet with NOAC, n (%) | 104 (7.2) | 31 (9.4) | 39 (6.3) | 34 (6.9) | 0.197 |
Apixaban | Dabigatran | Rivaroxaban | |||||||
---|---|---|---|---|---|---|---|---|---|
Factors | OR | 95% CI | p | OR | 95% CI | p | OR | 95% CI | p |
Age | 1.08 | 1.06–1.11 | <0.001 | 0.96 | 0.94–0.98 | <0.001 | 0.98 | 0.96–1.00 | 0.078 |
Gender | 1.04 | 0.81–1.33 | 0.761 | 0.79 | 0.64–0.98 | 0.031 | 1.25 | 1.00–1.56 | 0.048 |
Type of atrial fibrillation | |||||||||
Paroxysmal | 0.97 | 0.76–1.24 | 0.821 | 1.17 | 0.95–1.44 | 0.146 | 0.86 | 0.69–1.08 | 0.188 |
Persistent | 1.00 | 0.67–1.48 | 0.982 | 0.76 | 0.54–1.08 | 0.124 | 1.33 | 0.94–1.87 | 0.104 |
Permanent | 1.03 | 0.81–1.32 | 0.810 | 0.95 | 0.77–1.17 | 0.617 | 1.04 | 0.83–1.29 | 0.758 |
Non-permanent | 0.97 | 0.76–1.24 | 0.810 | 1.06 | 0.86–1.30 | 0.617 | 0.97 | 0.78–1.20 | 0.758 |
Medical history | |||||||||
Hypertension | 0.81 | 0.59–1.09 | 0.805 | 1.50 | 1.14–1.98 | 0.004 | 0.78 | 0.59–1.03 | 0.075 |
Heart failure | 1.23 | 0.93–1.61 | 0.143 | 0.93 | 0.74–1.16 | 0.502 | 0.93 | 0.74–1.18 | 0.552 |
Vascular disease | 1.10 | 0.86–1.41 | 0.451 | 1.05 | 0.85–1.29 | 0.654 | 0.88 | 0.71–1.10 | 0.258 |
Previous myocardial infarction | 1.31 | 0.99–1.73 | 0.058 | 0.98 | 0.77–1.25 | 0.870 | 0.82 | 0.63–1.06 | 0.133 |
PAD | 1.39 | 0.96–2.01 | 0.081 | 1.09 | 0.78–1.52 | 0.622 | 0.68 | 0.47–0.98 | 0.040 |
Previous stroke/TIA/peripheral embolism | 0.98 | 0.71–1.37 | 0.916 | 1.14 | 0.86–1.50 | 0.356 | 0.58 | 0.26–1.29 | 0.183 |
Diabetes mellitus | 1.16 | 0.86–1.45 | 0.420 | 0.94 | 0.75–1.17 | 0.562 | 0.99 | 0.78–1.25 | 0.914 |
Any previous bleeding | 3.03 | 1.78–5.13 | <0.001 | 0.67 | 0.39–1.17 | 0.159 | 0.48 | 0.25–0.90 | 0.023 |
Ulcer | 0.42 | 0.15–1.19 | 0.101 | 0.95 | 0.49–1.86 | 0.887 | 1.73 | 0.89–3.37 | 0.104 |
Malignancy | 1.28 | 0.77–2.13 | 0.337 | 0.82 | 0.52–1.30 | 0.394 | 1.01 | 0.63–1.62 | 0.970 |
Thromboembolic risk | |||||||||
CHA2DS2-VASC score | 1.03 | 0.94–1.12 | 0.539 | 1.01 | 0.94–1.09 | 0.736 | 0.97 | 0.89–1.04 | 0.372 |
Bleeding risk | |||||||||
HAS-BLED score | 0.91 | 0.78–1.08 | 0.283 | 1.21 | 1.05–1.39 | 0.008 | 0.87 | 0.76–1.01 | 0.068 |
≥3, n (%) | 0.71 | 0.54–0.94 | 0.015 | 1.20 | 0.96–1.50 | 0.101 | 1.06 | 0.84–1.33 | 0.650 |
Reason for hospitalisation | |||||||||
Electrical cardioversion | 0.77 | 0.45–1.30 | 0.329 | 1.04 | 0.69–1.58 | 0.850 | 1.16 | 0.75–1.78 | 0.505 |
Planned coronarography/PCI/ACS | 1.28 | 0.83–1.96 | 0.269 | 0.81 | 0.55–1.20 | 0.303 | 1.02 | 0.68–1.52 | 0.923 |
Heart failure | 1.60 | 1.23–2.08 | <0.001 | 0.92 | 0.73–1.16 | 0.458 | 0.74 | 0.58–0.95 | 0.018 |
Ablation | 0.45 | 0.10–1.97 | 0.288 | 0.55 | 0.19–1.58 | 0.268 | 2.76 | 1.05–7.30 | 0.040 |
CIED | 0.63 | 0.46–0.88 | 0.007 | 1.07 | 0.83–1.39 | 0.592 | 1.28 | 0.99–1.66 | 0.065 |
AF attack | 0.85 | 0.57–1.28 | 0.445 | 1.36 | 0.98–1.90 | 0.067 | 0.80 | 0.56–1.14 | 0.216 |
Laboratory test | |||||||||
Haemoglobin | 0.86 | 0.79–0.93 | <0.001 | 1.10 | 1.03–1.17 | 0.006 | 0.99 | 0.96–1.03 | 0.749 |
Platelet | 1.00 | 1.00–1.00 | 0.999 | 1.00 | 1.00–1.00 | 0.249 | 1.00 | 1.00–1.00 | 0.085 |
eGFR | 0.97 | 0.97–0.98 | <0.001 | 1.10 | 1.01–1.03 | <0.001 | 1.00 | 0.99–1.01 | 0.724 |
eGFR < 60 mL/min/1.73 m2 | 1.31 | 0.96–1.77 | 0.085 | 0.78 | 0.61–0.99 | 0.043 | 1.08 | 0.83–1.40 | 0.556 |
Echocardiographic findings | |||||||||
Ejection fraction | 0.99 | 0.98–1.00 | 0.007 | 1.01 | 1.00–1.01 | 0.166 | 1.00 | 1.00–1.01 | 0.857 |
Left ventricular systolic diameter | 1.00 | 0.98–1.01 | 0.633 | 1.01 | 1.00–1.03 | 0.048 | 0.99 | 0.98–1.00 | 0.097 |
Left ventricular diastolic diameter | 0.98 | 0.96–1.00 | 0.015 | 1.02 | 1.01–1.04 | 0.005 | 0.99 | 0.98–1.01 | 0.440 |
Reduced dose | 0.30 | 0.23–0.39 | <0.001 | 3.37 | 2.66–4.26 | <0.001 | 0.77 | 0.61–0.96 | 0.020 |
Antiplatelet with NOAC | 1.48 | 0.96–2.30 | 0.079 | 0.79 | 0.52–1.19 | 0.255 | 0.92 | 0.60–1.41 | 0.708 |
Apixaban 1 | Dabigatran 2 | Rivaroxaban 3 | |||||||
---|---|---|---|---|---|---|---|---|---|
Factors | OR | 95% CI | p | OR | 95% CI | p | OR | 95% CI | p |
Age | 1.08 | 1.05–1.11 | <0.001 | 0.96 | 0.94–0.98 | <0.001 | 0.98 | 0.96–1.00 | 0.094 |
Gender | 0.99 | 0.76–1.29 | 0.916 | 0.82 | 0.65–1.02 | 0.071 | 1.25 | 0.99–1.58 | 0.058 |
Hypertension | 0.80 | 0.58–1.10 | 0.168 | 1.56 | 1.18–2.06 | 0.022 | 0.74 | 0.56–0.98 | 0.034 |
PAD | 1.20 | 0.82–1.76 | 0.351 | 1.17 | 0.83–1.64 | 0.373 | 0.72 | 0.49–1.04 | 0.081 |
Any previous bleeding | 2.94 | 1.71–5.06 | <0.001 | 0.68 | 0.39–1.18 | 0.167 | 0.50 | 0.26–0.95 | 0.034 |
Heart failure | 1.28 | 0.96–1.71 | 0.093 | 0.98 | 0.76–1.26 | 0.873 | 0.83 | 0.63–1.08 | 0.157 |
Ablation | 0.59 | 0.13–2.64 | 0.491 | 0.52 | 0.18–1.51 | 0.228 | 2.39 | 0.89–6.41 | 0.084 |
CIED | 0.63 | 0.44–0.90 | 0.011 | 1.11 | 0.84–1.46 | 0.470 | 1.25 | 0.94–1.66 | 0.126 |
eGFR < 60 mL/min/1.73 m2 | 1.20 | 0.87–1.66 | 0.266 | 0.83 | 0.65–1.08 | 0.164 | 1.07 | 0.82–1.41 | 0.604 |
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Bielecka, B.; Gorczyca-Głowacka, I.; Wożakowska-Kapłon, B. Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs. Int. J. Environ. Res. Public Health 2022, 19, 11938. https://doi.org/10.3390/ijerph191911938
Bielecka B, Gorczyca-Głowacka I, Wożakowska-Kapłon B. Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs. International Journal of Environmental Research and Public Health. 2022; 19(19):11938. https://doi.org/10.3390/ijerph191911938
Chicago/Turabian StyleBielecka, Bernadetta, Iwona Gorczyca-Głowacka, and Beata Wożakowska-Kapłon. 2022. "Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs" International Journal of Environmental Research and Public Health 19, no. 19: 11938. https://doi.org/10.3390/ijerph191911938
APA StyleBielecka, B., Gorczyca-Głowacka, I., & Wożakowska-Kapłon, B. (2022). Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs. International Journal of Environmental Research and Public Health, 19(19), 11938. https://doi.org/10.3390/ijerph191911938