TY - JOUR
T1 - Warfarin use and mortality, stroke, and bleeding outcomes in a cohort of elderly patients with non-valvular atrial fibrillation
AU - Bradshaw , Pamela J.
AU - Joseph, Hung
AU - Matthew, Knuiman
AU - Briffa , Tomas G.
AU - Lee, Nedkoff
AU - Katzenellebogen , Judith K.
AU - Rankin Jamie, M.
AU - Sanfilippo, Frank
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Aims: To determine exposure to warfarin and the associated outcomes in a population of older patients with non-valvular atrial fibrillation (NVAF). Methods: Cohort study of patients aged 65-89 years admitted to hospital July 2003-December 2008 with newly-diagnosed or pre-existing AF. Outcomes at three years among one-year survivors post-index admission (landmark date) were all-cause mortality, stroke/systemic thromboembolism (stroke/TE) and bleeding. Multivariate Cox models were used to identify factors associated with each outcome. Results: AF was the principal diagnosis for 27.5% of 17,336 index AF admissions. Of 14,634 (84.4%) patients alive at one-year 1,384 (9.5%) died in the following year. Vascular disease (42%) was the most frequent cause of death. Warfarin use, prior to the index admission and/or the 1-year landmark, did not exceed 40%. Compared to non-exposure or discontinuation at the index admission, initiation or persistence with warfarin prior to the landmark date was associated with reduced risk for all-cause mortality, a statistically non-significant reduction in risk for stroke/TE, and an increased risk for bleeding. Higher CHA2DS2-VASc scores were associated with increased risk for each outcome. Conclusions: In a population-based cohort of hospitalised NVAF patients, the initiation and persistent use of warfarin was associated with lower all-cause mortality risk to three years, although reduction in risk for stroke/TE did not reach statistical significance. The apparent under-use of warfarin in this older, high-risk cohort reinforces the opportunity for further reduction in stroke/TE with the uptake of non-vitamin K oral anti-coagulants (NOACs) among those not prescribed, or not persistent with, warfarin.
AB - Aims: To determine exposure to warfarin and the associated outcomes in a population of older patients with non-valvular atrial fibrillation (NVAF). Methods: Cohort study of patients aged 65-89 years admitted to hospital July 2003-December 2008 with newly-diagnosed or pre-existing AF. Outcomes at three years among one-year survivors post-index admission (landmark date) were all-cause mortality, stroke/systemic thromboembolism (stroke/TE) and bleeding. Multivariate Cox models were used to identify factors associated with each outcome. Results: AF was the principal diagnosis for 27.5% of 17,336 index AF admissions. Of 14,634 (84.4%) patients alive at one-year 1,384 (9.5%) died in the following year. Vascular disease (42%) was the most frequent cause of death. Warfarin use, prior to the index admission and/or the 1-year landmark, did not exceed 40%. Compared to non-exposure or discontinuation at the index admission, initiation or persistence with warfarin prior to the landmark date was associated with reduced risk for all-cause mortality, a statistically non-significant reduction in risk for stroke/TE, and an increased risk for bleeding. Higher CHA2DS2-VASc scores were associated with increased risk for each outcome. Conclusions: In a population-based cohort of hospitalised NVAF patients, the initiation and persistent use of warfarin was associated with lower all-cause mortality risk to three years, although reduction in risk for stroke/TE did not reach statistical significance. The apparent under-use of warfarin in this older, high-risk cohort reinforces the opportunity for further reduction in stroke/TE with the uptake of non-vitamin K oral anti-coagulants (NOACs) among those not prescribed, or not persistent with, warfarin.
KW - Atrial Fibrillation
KW - Clinical Outcomes
KW - Landmark Analysis
KW - Linked Data
KW - Population Study
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=85073739202&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:85073739202
SN - 1941-6911
VL - 12
JO - JOURNAL OF ATRIAL FIBRILLATION
JF - JOURNAL OF ATRIAL FIBRILLATION
IS - 1
ER -