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Real‐world evidence that among atrial fibrillation patients warfarin is associated with reduced nonelective admissions compared with those on DOACs

Yu, Dahai; Brown, Julian; David Strain, W.; Simmons, David

Authors

Julian Brown

W. David Strain

David Simmons



Abstract

Background: Randomized trials show inconsistent estimates on risks of direct‐acting oral anticoagulants (DOACs) versus warfarin in bleeding and mortality for atrial fibrillation (AF) patients. Trials are confounded by additional DOAC adherence support, while warfarin has a low time in therapeutic range. Few real‐world studies compared emergency hospitalization risk between DOAC and warfarin users in AF. This study aimed to determine emergency hospitalization risk for AF patients on DOACs or warfarin in real‐world settings.

Methods: A tapered‐matched real‐world cohort extracted data from 412 English general practices' primary care records linked with emergency department (ED) and hospitalization data from the ECLIPSE database. AF patients with new DOAC or warfarin prescriptions were included. The primary outcome was all‐cause ED attendance; the secondary outcomes were ED re‐attendance, nonelective hospitalization, and rehospitalization within 12 months. Weighted Cox regression estimated relative risk difference.

Results: 39 201 DOAC patients were matched with 13 145 warfarin patients. DOAC patients had a 25% higher likelihood of attending ED (odds ratio 1.25; 95% confidence interval [CI] 1.01–1.55). DOAC use also associated with higher ED re‐attendance, nonelective hospitalization, and rehospitalization within 12 months: 1.41 (95% CI 1.00–1.98), 1.26 (1.00–1.57), and 1.54 (1.01–2.34), respectively, with p‐values < .05.

Conclusions: DOACs for AF thromboprophylaxis are associated with the increased risk of ED attendance, recurrent hospitalization, and numerical rise in ED re‐attendance and first nonelective hospitalization compared to warfarin. However, these real‐world data cannot establish if this difference results from medication adherence, lack of regular warfarin clinic monitoring, unmeasured confounders, or fundamental agent efficacy disparities.

Citation

Yu, D., Brown, J., David Strain, W., & Simmons, D. (2023). Real‐world evidence that among atrial fibrillation patients warfarin is associated with reduced nonelective admissions compared with those on DOACs. Clinical Cardiology, https://doi.org/10.1002/clc.24146

Journal Article Type Article
Acceptance Date Aug 24, 2023
Online Publication Date Sep 8, 2023
Publication Date Sep 8, 2023
Deposit Date Sep 11, 2023
Journal Clinical Cardiology
Print ISSN 0160-9289
Electronic ISSN 1932-8737
Publisher Wiley
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1002/clc.24146
Keywords tapered matching, ED, warfarin, bleeding, hospitalization, direct‐acting oral anticoagulants