Arrhythmias & electrophysiology
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
Authors' conclusion
Frailty 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.
Study context
- Population
- Atrial fibrillation (AF) patients initiating anticoagulation, 2013–2019, Belgium; frailty by Claims-based Frailty Indicator71,638 (28.2%) with frailty
- Participants
- 254,478 patients
- Exposure
- NOACs vs VKAs in AF patients with frailty
- Outcome
- Outcomes with NOACs vs VKAs in frailty
Methodological detailsnationwide, Belgian nationwide data
- Nationwide
- Belgian nationwide data
Main finding
As reported in the abstract
NOACs vs VKAsAdjusted hazard ratio (95% CI)
stroke/SE
0.77(0.70–0.86)
All-cause mortality
0.88(0.84–0.92)
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| Frailtyvs no frailty: all-cause mortality | 1.48 (1.43–1.54) | |
| 0.512Adjusted hazard ratio (log scale) |
Frailty vs no frailty: all-cause mortality
- Frailty not associated with thromboembolism or bleeding
All-cause mortality, apixaban vs dabigatran and edoxaban
- Mortality risk higher with apixaban vs dabigatran and edoxaban
Safety
| Outcome | aHR (95% CI) | |
|---|---|---|
| Bleeding, NOACs vs VKAsNOACsvs VKAsIntracranial bleeding | 0.78 (0.66–0.91) | |
| Bleeding, NOACs vs VKAsNOACsvs VKAsMajor bleeding | 1.01 (0.93–1.09) | |
| Bleeding, NOACs vs VKAsNOACsvs VKAsGastrointestinal bleeding | 1.19 (1.06–1.33) | |
| Major bleeding, individual NOACsApixabanvs VKAs | 0.84 (0.76–0.93) | |
| Major bleeding, individual NOACsEdoxabanvs VKAs | 0.91 (0.73–1.14) | |
| Major bleeding, individual NOACsDabigatranvs VKAs | 1.16 (1.03–1.30) | |
| Major bleeding, individual NOACsRivaroxabanvs VKAs | 1.11 (1.02–1.21) | |
| Major bleeding, individual NOACsApixabanvs Dabigatran | 0.72 (0.65–0.80) | |
| Major bleeding, individual NOACsApixabanvs Rivaroxaban | 0.78 (0.72–0.84) | |
| Major bleeding, individual NOACsApixabanvs Edoxaban | 0.74 (0.65–0.84) | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
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. Eur Heart J Qual Care Clin Outcomes. Published 20 March 2023. doi:10.
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