Prognostic implications of adherence to oral anticoagulants among patients with atrial fibrillation: Insights from MISOAC-AF trial.
J Cardiol
; 81(4): 390-396, 2023 04.
Article
in En
| MEDLINE
| ID: mdl-36179772
ABSTRACT
OBJECTIVES:
To explore the implications of adherence to oral anticoagulants (OACs) on all-cause mortality and cardiovascular outcomes in patients with atrial fibrillation (AF).METHODS:
This post-hoc analysis of the MISOAC-AF trial included recently hospitalized patients with AF. Adherence to OACs was assessed by the proportion of days covered (PDC). Good adherence was defined as PDC >80â¯%. Cox regression models were used to associate PDC with clinical outcomes of all-cause death, cardiovascular death (CVD), stroke, and bleeding. A sub-analysis was performed among adherent patients to compare outcomes between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs).RESULTS:
During a median 31-month follow-up, 778 cardiac patients with comorbid AF who had been prescribed OACs upon hospital discharge were studied. The mean PDC was 0.78; 66â¯% of patients had good adherence (>80â¯%) which was associated with lower risk of all-cause death [adjusted hazard ratio (aHR) 0.64; 95â¯% confidence interval (CI) 0.46 to 0.84, pâ¯<â¯0.001] and CVD (aHR 0.70; 95â¯% CI 0.50 to 0.97, pâ¯=â¯0.03). The risk of stroke and major or non-major bleeding did not differ by adherence status. Among adherent patients to OACs, VKA use was associated with higher rates of all-cause death (pâ¯<â¯0.001), CVD (pâ¯<â¯0.001), and stroke (pâ¯=â¯0.01); no differences were found regarding major or non-major bleeding risk.CONCLUSIONS:
In recently hospitalized patients with AF, good adherence to OACs was associated with a reduced risk of all-cause death and CVD. The rates of stroke or bleeding events were not significantly different. VKAs were associated with more adverse events compared to DOACs.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Atrial Fibrillation
/
Stroke
Type of study:
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
J Cardiol
Journal subject:
CARDIOLOGIA
Year:
2023
Document type:
Article
Affiliation country: