Impact of frailty on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a nationwide cohort study.

Content Provider	Europe PMC
Author	Grymonprez, Maxim Petrovic, Mirko De Backer, Tine L Steurbaut, Stephane Lahousse, Lies
Copyright Year	2023
Description	Graphical Abstract Graphical AbstractAF: atrial fibrillation; aHR: adjusted hazard ratio; Api: apixaban; CI: confidence interval; Dabi: dabigatran; Edo: edoxaban; IPTW: inverse probability of treatment weighting; NOAC: non-vitamin K antagonist oral anticoagulant; OAC: oral anticoagulant; Ref: reference category; Riva: rivaroxaban; SE: systemic embolism; VKA: vitamin K antagonist.
Abstract	AimsData on non-vitamin K antagonist oral anticoagulants (NOACs) use in patients with atrial fibrillation (AF) and frailty are scarce. Therefore, the impact of frailty on AF-related outcomes and benefit–risk profiles of NOACs in patients with frailty were investigated.Methods and resultsAF patients initiating anticoagulation between 2013 and 2019 were included using Belgian nationwide data. Frailty was assessed with the Claims-based Frailty Indicator. Among 254 478 anticoagulated AF patients, 71 638 (28.2%) had frailty. Frailty was associated with higher all-cause mortality risks [adjusted hazard ratio (aHR) 1.48, 95% confidence interval (CI) (1.43–1.54)], but not with thromboembolism or bleeding. Among subjects with frailty (78 080 person-years of follow-up), NOACs were associated with lower risks of stroke or systemic embolism (stroke/SE) [aHR 0.77, 95%CI (0.70–0.86)], all-cause mortality [aHR 0.88, 95%CI (0.84–0.92)], and intracranial bleeding [aHR 0.78, 95%CI (0.66–0.91)], a similar major bleeding risk [aHR 1.01, 95%CI (0.93–1.09)], and higher gastrointestinal bleeding risk [aHR 1.19, 95%CI (1.06–1.33)] compared with VKAs. Major bleeding risks were lower with apixaban [aHR 0.84, 95%CI (0.76–0.93)], similar with edoxaban [aHR 0.91, 95%CI (0.73–1.14)], and higher with dabigatran [aHR 1.16, 95%CI (1.03–1.30)] and rivaroxaban [aHR 1.11, 95%CI (1.02–1.21)] compared with VKAs. Apixaban was associated with lower major bleeding risks compared with dabigatran [aHR 0.72, 95%CI (0.65–0.80)], rivaroxaban [aHR 0.78, 95%CI (0.72–0.84)] and edoxaban [aHR 0.74, 95%CI (0.65–0.84)], but mortality risk was higher compared with dabigatran and edoxaban.ConclusionFrailty was an independent risk factor of death. Non-vitamin K antagonist oral anticoagulants had better benefit–risk profiles than VKAs in patients with frailty, especially apixaban, followed by edoxaban.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC10785587&blobtype=pdf
Page Count	11
ISSN	20585225
Volume Number	10
DOI	10.1093/ehjqcco/qcad019
PubMed Central reference number	PMC10785587
Issue Number	1
PubMed reference number	36941126
Journal	European Heart Journal. Quality of Care & Clinical Outcomes [Eur Heart J Qual Care Clin Outcomes]
e-ISSN	20581742
Language	English
Publisher	Oxford University Press
Publisher Date	2024-01-01
Access Restriction	Open
Rights License	This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Subject Keyword	Atrial fibrillation Frailty Anticoagulant Thromboembolism Bleeding Death
Content Type	Text
Resource Type	Article
Subject	Health Policy Cardiology and Cardiovascular Medicine