scholarly journals PMD132 - REAL-WORLD ECONOMIC AND CLINICAL OUTCOMES FOR PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING RADIOFREQUENCY ABLATION USING THERMOCOOL® SF CATHETER VERSUS THERMOCOOL® CATHETER

2018 ◽  
Vol 21 ◽  
pp. S265
Author(s):  
L. Chinitz ◽  
L.J. Goldstein ◽  
A. Barnow ◽  
M. Daskiran ◽  
I. Kalsekar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Clinical Outcomes ◽  
Real World ◽  
World Economic

scholarly journals Real-World Management and Clinical Outcomes of Stroke Survivors With Atrial Fibrillation: A Population-Based Cohort in Spain

2021 ◽  
Vol 12 ◽  
Author(s):  
Clara L. Rodríguez-Bernal ◽  
Francisco Sanchez-Saez ◽  
Daniel Bejarano-Quisoboni ◽  
Judit Riera-Arnau ◽  
Gabriel Sanfélix-Gimeno ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Real World ◽  
Large Population ◽  
Temporal Trends ◽  
Population Based ◽  
Stroke Survivors ◽  
Gi Bleeding ◽  
Management Pattern ◽  
Time To Treatment

Objective: Despite the continuous update of clinical guidelines, little is known about the real-world management of patients with atrial fibrillation (AF) who survived a stroke. We aimed to assess patterns of therapeutic management of stroke survivors with AF and clinical outcomes using data from routine practice in a large population-based cohort.Methods: A population-based retrospective cohort study of all patients with AF who survived a stroke, from January 2010 to December 2017 in the Valencia region, Spain (n = 10,986), was carried out. Treatment strategies and mean time to treatment initiation are described. Temporal trends are shown by the management pattern during the study period. Factors associated with each pattern (including no treatment) vs. oral anticoagulant (OAC) treatment were identified using logistic multivariate regression models. Incidence rates of clinical outcomes (mortality, stroke/TIA, GI bleeding, and ACS) were also estimated by the management pattern.Results: Among stroke survivors with AF, 6% were non-treated, 23% were prescribed antiplatelets (APT), 54% were prescribed OAC, and 17% received OAC + APT at discharge. Time to treatment was 8.0 days (CI 7.6–8.4) for APT, 9.86 (CI 9.52–10.19) for OAC, and 16.47 (CI 15.86–17.09) for OAC + APT. Regarding temporal trends, management with OAC increased by 20%, with a decrease of 50% for APT during the study period. No treatment and OAC + APT remained relatively stable. The strongest predictor of no treatment and APT treatment was having the same management strategy pre-stroke. Those treated with APT had the highest rates of GI bleeding and recurrent stroke/TIA, and untreated patients showed the highest rates of mortality.Conclusion: In this large population-based cohort using real-world data, nearly 30% of AF patients who suffered a stroke were untreated or treated with APT, which overall is not recommended. Treatment was started within 2 weeks as recommended, except for OAC + APT, which was started later. The strong association of APT treatment or non-treatment with the same treatment strategy before stroke occurrence suggests a strong therapeutic inertia and opposes recommendations. Patients under these two strategies had the highest rates of adverse outcomes. An inadequate prescription poses a great risk on patients with AF and stroke; thus monitoring their management is necessary and should be setting-specific.

scholarly journals Comparison of clinical outcomes with edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonist in patients with atrial fibrillation in Germany: a real-world cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.L Marston ◽  
R Wang ◽  
Y.C Yeh ◽  
L Zimmermann ◽  
X Ye ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Major Bleeding ◽  
Real World ◽  
Lower Risk ◽  
Sensitivity Analyses ◽  
Funding Source ◽  
Baseline Characteristics

Abstract Background Vitamin K antagonists (VKA) and non-VKA oral anticoagulants (NOACs) are used to prevent thromboembolic conditions in patients with atrial fibrillation (AF). Unlike VKA, NOACs have fixed dosage schemes, do not require regular laboratory tests, and have fewer drug and food interactions. The use of NOACs has increased substantially in recent years in Germany. However, there is limited evidence on the comparative effectiveness and safety between different NOACs and VKA in real-world settings. Purpose The objective of the study was to compare the clinical outcomes, including systemic embolism (SE), ischemic stroke (IS), and major bleeding, of edoxaban with other NOACs (apixaban, dabigatran, rivaroxaban) and VKA in AF patients in Germany. Methods Using an administrative database from our institution (Deutsche Analysedatenbank für Evaluation und Versorgungsforschung) between January 2013 and December 2017, a retrospective cohort study was conducted to compare the effectiveness (risk of SE or IS) and safety (risk of major bleeding) in NOAC-naïve AF patients who initiated anticoagulant therapy. Continuous enrolment for 12 months before anticoagulant initiation was required to assess baseline characteristics. Patients were followed up until (1) the first outcome event (SE, IS, or major bleeding), (2) disenrollment from health plans, or (3) discontinuation of the index NOAC or VKA or therapy switch, whichever occurred first. Inverse probability treatment weighting (IPTW) using propensity score was applied to control for differences in baseline characteristics. Cox proportional hazards models were used to estimate the hazard ratios (HR) for each outcome comparing edoxaban versus other NOACs and VKA. Sensitivity analyses were conducted with follow-up period cut-off at 1 year. Results A total of 1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA patients were included. Patient cohorts were well balanced after weighting. The adjusted risks of SE or IS were lower for edoxaban compared to apixaban (HR 0.83, 95% CI 0.69–0.99), dabigatran (HR 0.54, 95% CI 0.40–0.74), rivaroxaban (HR 0.72, 95% CI 0.60–0.87), and VKA (HR 0.65, 95% CI 0.53–0.78) (all p<0.05). Edoxaban was associated with a significantly lower risk of major bleeding compared to dabigatran (HR 0.73, 95% CI 0.55–0.98), rivaroxaban (HR 0.74, 95% CI 0.63–0.87), and VKA (HR 0.47, 95% CI 0.40–0.55) (all p<0.05). The risk of major bleeding was comparable between edoxaban and apixaban (HR 1.09, 95% CI 0.92–1.30, p=0.33). Results were consistent in the sensitivity analyses. Conclusions Edoxaban was associated with a significantly lower risk of SE or IS compared to other NOACs and VKA, indicating improved effectiveness. Edoxaban also had a favourable safety profile with a significantly lower risk of major bleeding compared to dabigatran, rivaroxaban, and VKA. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc.

scholarly journals Real-world clinical outcomes and anticoagulant therapy in elderly non-valvular atrial fibrillation patients with heart failure: sub-analysis of the ANAFIE Registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Ikeda ◽  
K Hiasa ◽  
H Tsutsui ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Real World ◽  
Reference Group ◽  
Incidence Rates ◽  
Female Ratio ◽  
All Cause Mortality

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are bidirectionally correlated; the more severe the NYHA classification, the higher the incidence rate of atrial fibrillation, and vice versa. HF is included in the items of CHA2DS2-VASc score used to calculate stroke risk in patients with AF, and is itself a risk factor for thromboembolism in such patients. Anticoagulant management in AF patients with HF is thus a key concern that remains to be sufficiently examined, especially in elderly patients aged ≥75 y. Purpose The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry enrolled more than 30,000 elderly (≥75 y) patients with non-valvular AF (NVAF), aiming to produce real-world data on their clinical status and prognosis. This sub-analysis of the ANAFIE Registry assessed the 2-year outcomes and status of anticoagulant treatment in elderly NVAF patients with HF. Methods A total of 32,275 patients from the ANAFIE Registry were divided into two groups according to whether they had HF (HF group and reference group). The incidence rates and adjusted hazard ratios (HR) of clinical outcomes were determined using Kaplan-Meier analysis and the Cox proportional-hazards model, respectively. Results A total of 20,159 (62.5%) patients were included in the reference group, and 12,116 (37.5%) in the HF group. Compared with the reference group, the HF group had higher mean age (82.4 vs 80.9 y), female ratio (46.6% vs 40.4%), non-paroxysmal AF (69.8% vs 50.8%), and had lower mean CrCL (43.3 vs 51.6 mL/min). In the HF group, the rate control drugs were frequently used (50.1% vs 35.8%), and the rhythm control drugs were less used (14.2% vs 22.7%) than in the reference group. More patients in the HF group were using anticoagulants (93.9% vs 91.6%; warfarin (WF), 29.6% vs 23.0%; direct oral anticoagulants (DOAC), 64.2% vs 68.5%) than those in the reference group. The HF group had a numerically higher incidence of stroke or systemic embolic events (SEE) (3.28% vs 2.84%, HR 0.96, p=0.558) and major bleeding (2.35% vs 1.79%, HR 1.14, p=0.130) than the reference group, but the differences were not statistically significant. The HF group had a significantly higher incidence rate of HF requiring hospitalization (12.99% vs 4.59%, HR 1.94, p<0.001) and all-cause mortality (9.83% vs 5.21%, HR 1.32, p<0.001). In the HF group, patients receiving DOAC had significantly lower incidence rates for major bleeding, HF requiring hospitalization, and all-cause mortality than those receiving WF, while there was no difference for stroke/SEE between both groups. Conclusions Elderly NVAF patients with HF had higher risk of HF requiring hospitalization and mortality than those without. Differences were seen in the incidence rates of major bleeding, HF requiring hospitalization, and all-cause mortality between patients on DOAC and those on WF. This study will explore relevant factors affecting clinical outcomes in elderly NVAF patients with HF. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.

Sign in / Sign up

Export Citation Format

Share Document