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51. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)

Author

Piepoli, Massimo F., Hoes, Arno W., Agewall, Stefan, Albus, Christian, Brotons, Carlos, Catapano, Alberico L., Cooney, Marie-Therese, Corrà, Ugo, Cosyns, Bernard, Deaton, Christi, Graham, Ian, Hall, Michael Stephen, Hobbs, F.D. Richard, Løchen, Maja-Lisa, Löllgen, Herbert, Marques-Vidal, Pedro, Perk, Joep, Prescott, Eva, Redon, Josep, Richter, Dimitrios J., Sattar, Naveed, Smulders, Yvo, Tiberi, Monica, Bart van der Worp, H., van Dis, Ineke, and Verschuren, W.M. Monique

Published
2016
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56. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC

Author

McDonagh, Theresa A, Metra, Marco, Adamo, Marianna, Gardner, Roy S, Baumbach, Andreas, Böhm, Michael, Burri, Haran, Butler, Javed, Čelutkienė, Jelena, Chioncel, Ovidiu, Cleland, John G F, Crespo-Leiro, Maria Generosa, Farmakis, Dimitrios, Gilard, Martine, Heymans, Stephane, Hoes, Arno W, Jaarsma, Tiny, Jankowska, Ewa A, Lainscak, Mitja, and Lam, Carolyn S P

Subjects
HEART failure, TASK forces, MEDICAL care, BRAIN natriuretic factor, MEDICAL personnel, DIAGNOSIS
Abstract

After due deliberation, the Task Force decided to update recommendations for the following sections of the 2021 ESC HF Guidelines: Chronic HF: HF with mildly reduced ejection fraction (HFmrEF) and HFpEF Acute HF Comorbidities and prevention of HF. 3. HF events were defined as HF hospitalizations, urgent HF visits, and unplanned outpatient HF visits. Acute heart failure Treatment of acute HF was outlined in the recent 2021 ESC HF Guidelines and a Heart Failure Association scientific statement on HF.[1],[25] Since these publications, trials have been conducted with diuretics, as well as on management strategies for patients with acute HF. [Extracted from the article]

Published
2023
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66. Development and validation of a prediction rule for patients suspected of acute coronary syndrome in primary care: a cross-sectional study

Author

Wouters, Loes T C M, primary, Zwart, Dorien L M, additional, Erkelens, Daphne C A, additional, Adriaansen, Elisabeth J M, additional, den Ruijter, Hester M, additional, De Groot, Esther, additional, Damoiseaux, Roger A M J, additional, Hoes, Arno W, additional, van Smeden, Maarten, additional, and Rutten, Frans H, additional

Published
2022
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77. ‘heartfailurematters.org’, an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions

Author

Wagenaar, Kim P., Rutten, Frans H., Klompstra, Leonie, Bhana, Yusuf, Sieverink, Floor, Ruschitzka, Frank, Seferovic, Petar M., Lainscak, Mitja, Piepoli, Massimo F., Broekhuizen, Berna D.L., Strömberg, Anna, Jaarsma, Tiny, Hoes, Arno W., and Dickstein, Kenneth

Published
2017
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83. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC

Author

McDonagh, Theresa A., primary, Metra, Marco, additional, Adamo, Marianna, additional, Gardner, Roy S., additional, Baumbach, Andreas, additional, Böhm, Michael, additional, Burri, Haran, additional, Butler, Javed, additional, Čelutkienė, Jelena, additional, Chioncel, Ovidiu, additional, Cleland, John G.F., additional, Coats, Andrew J.S., additional, Crespo-Leiro, Maria G., additional, Farmakis, Dimitrios, additional, Gilard, Martine, additional, Heymans, Stephane, additional, Hoes, Arno W., additional, Jaarsma, Tiny, additional, Jankowska, Ewa A., additional, Lainscak, Mitja, additional, Lam, Carolyn S.P., additional, Lyon, Alexander R., additional, McMurray, John J.V., additional, Mebazaa, Alexandre, additional, Mindham, Richard, additional, Muneretto, Claudio, additional, Piepoli, Massimo Francesco, additional, Price, Susanna, additional, Rosano, Giuseppe M.C., additional, Ruschitzka, Frank, additional, and Skibelund, Anne Kathrine, additional

Published
2022
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88. Safety of off-label dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

Author

Afd Pharmacoepi & Clinical Pharmacology, Sub Biomol.Mass Spectrometry & Proteom., Pharmacoepidemiology and Clinical Pharmacology, Biomolecular Mass Spectrometry and Proteomics, van den Dries, Carline J., Pajouheshnia, Romin, van den Ham, Hendrika A., Souverein, Patrick, Moons, Karel G.M., Hoes, Arno W., Geersing, Geert Jan, van Doorn, Sander, Afd Pharmacoepi & Clinical Pharmacology, Sub Biomol.Mass Spectrometry & Proteom., Pharmacoepidemiology and Clinical Pharmacology, Biomolecular Mass Spectrometry and Proteomics, van den Dries, Carline J., Pajouheshnia, Romin, van den Ham, Hendrika A., Souverein, Patrick, Moons, Karel G.M., Hoes, Arno W., Geersing, Geert Jan, and van Doorn, Sander

Published
2022

89. Generalizability of randomized controlled trials in heart failure with reduced ejection fraction

Author

Lim, Yvonne Mei Fong, Molnar, Megan, Vaartjes, Ilonca, Savarese, Gianluigi, Eijkemans, Marinus J.C., Uijl, Alicia, Vradi, Eleni, Suzart-Woischnik, Kiliana, Brugts, Jasper J., Brunner-La Rocca, Hans Peter, Blanc-Guillemaud, Vanessa, Couvelard, Fabrice, Baudier, Claire, Dyszynski, Tomasz, Waechter, Sandra, Lund, Lars H., Hoes, Arno W., Tyl, Benoit, Asselbergs, Folkert W., Gerlinger, Christoph, Grobbee, Diederick E., Cronin, Maureen, Koudstaal, Stefan, Lim, Yvonne Mei Fong, Molnar, Megan, Vaartjes, Ilonca, Savarese, Gianluigi, Eijkemans, Marinus J.C., Uijl, Alicia, Vradi, Eleni, Suzart-Woischnik, Kiliana, Brugts, Jasper J., Brunner-La Rocca, Hans Peter, Blanc-Guillemaud, Vanessa, Couvelard, Fabrice, Baudier, Claire, Dyszynski, Tomasz, Waechter, Sandra, Lund, Lars H., Hoes, Arno W., Tyl, Benoit, Asselbergs, Folkert W., Gerlinger, Christoph, Grobbee, Diederick E., Cronin, Maureen, and Koudstaal, Stefan

Abstract

BACKGROUND: Heart failure (HF) trials have stringent inclusion and exclusion criteria, but limited data exist regarding generalizability of trials. We compared patient characteristics and outcomes between patients with HF and reduced ejection fraction (HFrEF) in trials and observational registries. METHODS AND RESULTS: Individual patient data for 16 922 patients from five randomized clinical trials and 46 914 patients from two HF registries were included. The registry patients were categorized into trial-eligible and non-eligible groups using the most commonly used inclusion and exclusion criteria. A total of 26 104 (56%) registry patients fulfilled the eligibility criteria. Unadjusted all-cause mortality rates at 1 year were lowest in the trial population (7%), followed by trial-eligible patients (12%) and trial-non-eligible registry patients (26%). After adjustment for age and sex, all-cause mortality rates were similar between trial participants and trial-eligible registry patients [standardized mortality ratio (SMR) 0.97; 95% confidence interval (CI) 0.92-1.03] but cardiovascular mortality was higher in trial participants (SMR 1.19; 1.12-1.27). After full case-mix adjustment, the SMR for cardiovascular mortality remained higher in the trials at 1.28 (1.20-1.37) compared to RCT-eligible registry patients. CONCLUSION: In contemporary HF registries, over half of HFrEF patients would have been eligible for trial enrolment. Crude clinical event rates were lower in the trials, but, after adjustment for case-mix, trial participants had similar rates of survival as registries. Despite this, they had about 30% higher cardiovascular mortality rates. Age and sex were the main drivers of differences in clinical outcomes between HF trials and observational HF registries.

Published
2022

90. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC

Author

McDonagh, Theresa A., Metra, Marco, Adamo, Marianna, Gardner, Roy S., Baumbach, Andreas, Boehm, Michael, Burri, Haran, Butler, Javed, Celutkien, Jelena, Chioncel, Ovidiu, Cleland, John G. F., Coats, Andrew J. S., Crespo-Leiro, Maria G., Farmakis, Dimitrios, Gilard, Martine, Heymans, Stephane, Hoes, Arno W., Jaarsma, Tiny, Jankowska, Ewa A., Lainscak, Mitja, Lam, Carolyn S. P., Lyon, Alexander R., McMurray, John J. V, Mebazaa, Alexandre, Mindham, Richard, Muneretto, Claudio, Francesco Piepoli, Massimo, Price, Susanna, Rosano, Giuseppe M. C., Ruschitzka, Frank, Skibelund, Anne Kathrine, McDonagh, Theresa A., Metra, Marco, Adamo, Marianna, Gardner, Roy S., Baumbach, Andreas, Boehm, Michael, Burri, Haran, Butler, Javed, Celutkien, Jelena, Chioncel, Ovidiu, Cleland, John G. F., Coats, Andrew J. S., Crespo-Leiro, Maria G., Farmakis, Dimitrios, Gilard, Martine, Heymans, Stephane, Hoes, Arno W., Jaarsma, Tiny, Jankowska, Ewa A., Lainscak, Mitja, Lam, Carolyn S. P., Lyon, Alexander R., McMurray, John J. V, Mebazaa, Alexandre, Mindham, Richard, Muneretto, Claudio, Francesco Piepoli, Massimo, Price, Susanna, Rosano, Giuseppe M. C., Ruschitzka, Frank, and Skibelund, Anne Kathrine

Abstract

n/a, All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines (C) For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online

Published
2022
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91. Heart failure with preserved, mid-range, and reduced ejection fraction across health care settings:an observational study

Author

de Boer, Annemarijn R., Vaartjes, Ilonca, Gohar, Aisha, Valk, Mark J.M., Brugts, Jasper J., Boonman-de Winter, Leandra J.M., van Riet, Evelien E., van Mourik, Yvonne, Brunner-La Rocca, Hans Peter, Linssen, Gerard C.M., Hoes, Arno W., Bots, Michiel L., den Ruijter, Hester M., Rutten, Frans H., de Boer, Annemarijn R., Vaartjes, Ilonca, Gohar, Aisha, Valk, Mark J.M., Brugts, Jasper J., Boonman-de Winter, Leandra J.M., van Riet, Evelien E., van Mourik, Yvonne, Brunner-La Rocca, Hans Peter, Linssen, Gerard C.M., Hoes, Arno W., Bots, Michiel L., den Ruijter, Hester M., and Rutten, Frans H.

Abstract

Aims: This study aimed to assess the sex-specific distribution of heart failure (HF) with preserved, mid-range, and reduced ejection fraction across three health care settings. Methods and results: In this descriptive observational study, we retrieved the distribution of HF types [with reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF)] for men and women between 65 and 79 years of age in three health care settings from a single country: (i) patients with screening-detected HF in the high-risk community (i.e. those with shortness of breath, frailty, diabetes mellitus, and chronic obstructive pulmonary disease) from four screening studies, (ii) patients with confirmed HF from primary care derived from a single observational study, and (iii) patients with confirmed HF from outpatient cardiology clinics participating in a registry. Among 1407 patients from the high-risk community, 288 had screen-detected HF (15% HFrEF, 12% HFmrEF, 74% HFpEF), and 51% of the screen-detected HF patients were women. In both women (82%) and men (65%), HFpEF was the most prevalent HF type. In the routine general practice population (30 practices, 70 000 individuals), among the 160 confirmed HF cases, 35% had HFrEF, 23% HFmrEF, and 43% HFpEF, and in total, 43% were women. In women, HFpEF was the most prevalent HF type (52%), while in men, this was HFrEF (41%). In outpatient cardiology clinics (n = 34), of the 4742 HF patients (66% HFrEF, 15% HFmrEF, 20% HFpEF), 36% were women. In both women (56%) and men (71%), HFrEF was the most prevalent HF type. Conclusions: Both HF types and sex distribution vary considerably in HF patients of 65–79 years of age among health care settings. From the high-risk community through to general practice to the cardiology outpatient setting, there is a shift in HF type from HFpEF to HFrEF and a decrease in the proportion of HF patients that are women.

Published
2022

92. Missed Acute Coronary Syndrome During Telephone Triage at Out-of-Hours Primary Care: Lessons From A Case-Control Study

Author

General Practice & Nursing Science, Other research (not in main researchprogram), HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Huisartsopleiding, Infection & Immunity, Directie Raad van Bestuur, JC Overig onderzoek, Erkelens, Daphne C., Rutten, Frans H., Wouters, Loes T., Kirkels, Harmke G., Poldervaart, Judith M., de Groot, Esther, Damoiseaux, Roger A., Hoes, Arno W., Zwart, Dorien L., General Practice & Nursing Science, Other research (not in main researchprogram), HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Huisartsopleiding, Infection & Immunity, Directie Raad van Bestuur, JC Overig onderzoek, Erkelens, Daphne C., Rutten, Frans H., Wouters, Loes T., Kirkels, Harmke G., Poldervaart, Judith M., de Groot, Esther, Damoiseaux, Roger A., Hoes, Arno W., and Zwart, Dorien L.

Published
2022

93. Development and validation of a prediction rule for patients suspected of acute coronary syndrome in primary care: a cross-sectional study

Author

HAG Hart- Vaatziekten, Circulatory Health, General Practice & Nursing Science, Other research (not in main researchprogram), Onderzoek Vrouw Hart & Vaatziekten, Huisartsopleiding, Infection & Immunity, Directie Raad van Bestuur, Epi Methoden Team 3, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Wouters, Loes T. C. M., Zwart, Dorien L. M., Erkelens, Daphne C. A., Adriaansen, Elisabeth J. M., den Ruijter, Hester M., De Groot, Esther, Damoiseaux, Roger A. M. J., Hoes, Arno W., van Smeden, Maarten, Rutten, Frans H., HAG Hart- Vaatziekten, Circulatory Health, General Practice & Nursing Science, Other research (not in main researchprogram), Onderzoek Vrouw Hart & Vaatziekten, Huisartsopleiding, Infection & Immunity, Directie Raad van Bestuur, Epi Methoden Team 3, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Wouters, Loes T. C. M., Zwart, Dorien L. M., Erkelens, Daphne C. A., Adriaansen, Elisabeth J. M., den Ruijter, Hester M., De Groot, Esther, Damoiseaux, Roger A. M. J., Hoes, Arno W., van Smeden, Maarten, and Rutten, Frans H.

Published
2022

94. Atrial fibrillation: trends in prevalence and antithrombotic prescriptions in the community

Author

HAG Trombose, Epi Infectieziekten Team 1, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Directie Raad van Bestuur, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, HAG Hart- Vaatziekten, Joosten, L. P.T., de Boer, A. R., van Eerde, E. J.B., van Doorn, S., Hoes, A. W., Bots, M. L., Rutten, F. H., Geersing, G. J., HAG Trombose, Epi Infectieziekten Team 1, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Directie Raad van Bestuur, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, HAG Hart- Vaatziekten, Joosten, L. P.T., de Boer, A. R., van Eerde, E. J.B., van Doorn, S., Hoes, A. W., Bots, M. L., Rutten, F. H., and Geersing, G. J.

Published
2022

95. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC

Author

McDonagh, Theresa A, Metra, Marco; https://orcid.org/0000-0001-6691-8568, Adamo, Marianna, Gardner, Roy S, Baumbach, Andreas, Böhm, Michael, Burri, Haran, Butler, Javed, Čelutkienė, Jelena, Chioncel, Ovidiu; https://orcid.org/0000-0002-3197-3628, Cleland, John G F; https://orcid.org/0000-0002-1471-7016, Coats, Andrew J S; https://orcid.org/0000-0002-2771-4260, Crespo-Leiro, Maria G; https://orcid.org/0000-0002-3085-167X, Farmakis, Dimitrios, Gilard, Martine, Heymans, Stephane, Hoes, Arno W, Jaarsma, Tiny, Jankowska, Ewa A; https://orcid.org/0000-0002-9202-432X, Lainscak, Mitja; https://orcid.org/0000-0002-5922-4098, Lam, Carolyn S P, Lyon, Alexander R; https://orcid.org/0000-0001-8026-840X, McMurray, John J V, Mebazaa, Alexandre, Mindham, Richard, Muneretto, Claudio, Piepoli, Massimo Francesco; https://orcid.org/0000-0003-1124-234X, Price, Susanna, Rosano, Giuseppe M C, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Skibelund, Anne Kathrine, McDonagh, Theresa A, Metra, Marco; https://orcid.org/0000-0001-6691-8568, Adamo, Marianna, Gardner, Roy S, Baumbach, Andreas, Böhm, Michael, Burri, Haran, Butler, Javed, Čelutkienė, Jelena, Chioncel, Ovidiu; https://orcid.org/0000-0002-3197-3628, Cleland, John G F; https://orcid.org/0000-0002-1471-7016, Coats, Andrew J S; https://orcid.org/0000-0002-2771-4260, Crespo-Leiro, Maria G; https://orcid.org/0000-0002-3085-167X, Farmakis, Dimitrios, Gilard, Martine, Heymans, Stephane, Hoes, Arno W, Jaarsma, Tiny, Jankowska, Ewa A; https://orcid.org/0000-0002-9202-432X, Lainscak, Mitja; https://orcid.org/0000-0002-5922-4098, Lam, Carolyn S P, Lyon, Alexander R; https://orcid.org/0000-0001-8026-840X, McMurray, John J V, Mebazaa, Alexandre, Mindham, Richard, Muneretto, Claudio, Piepoli, Massimo Francesco; https://orcid.org/0000-0003-1124-234X, Price, Susanna, Rosano, Giuseppe M C, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, and Skibelund, Anne Kathrine

Abstract

Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of inte

Published
2022

97. Managing the Increasing Burden of Atrial Fibrillation through Integrated Care in Primary Care: A CostEffectiveness Analysis.

Author

VAN DEN DRIES, CARLINE J., VAN DER MEULEN, MIRIAM P., FREDERIX, GEERT W. J., HOES, ARNO W., MOONS, KAREL G. M., and GEERSING, GEERT-JAN

Subjects
ATRIAL fibrillation treatment, PRIMARY health care, COST effectiveness, DESCRIPTIVE statistics, QUESTIONNAIRES, RESEARCH funding, INTEGRATED health care delivery, DATA analysis software, QUALITY-adjusted life years
Abstract

Introduction: Integrated care for patients with atrial fibrillation (AF) in primary care reduced mortality compared to usual care. We assessed the cost-effectiveness of this approach. Methods: Dutch primary care practices were randomised to provide integrated care for AF patients or usual care. A cost-effectiveness analysis was performed from a societal perspective with a 2-year time horizon to estimate incremental costs and Quality Adjusted Life Years (QALYs). A sensitivity analysis was performed, imputing missing questionnaires for a large group of usual care patients. Results: 522 patients from 15 intervention practices were compared to 425 patients from 11 usual care practices. No effect on QALYs was seen, while mean costs indicated a cost reduction between €865 (95% percentile interval (PI) –€5730 to €3641) and €1343 (95% PI –€6534 to €3109) per patient per 2 years. The cost-effectiveness probability ranged between 36% and 54%. In the sensitivity analysis, this increased to 95%-99%. Discussion: Results should be interpreted with caution due to missing information for a large proportion of usual care patients. Conclusion: The higher costs from extra primary care consultations were likely outweighed by cost reductions for other resources, yet this study doesn’t give sufficient clarity on the cost-effectiveness of integrated AF care. [ABSTRACT FROM AUTHOR]

Published
2023
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98. Safety of off‐label dose reduction of non‐vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.

Author

van den Dries, Carline J., Pajouheshnia, Romin, van den Ham, Hendrika A., Souverein, Patrick, Moons, Karel G. M., Hoes, Arno W., Geersing, Geert‐Jan, and van Doorn, Sander

Subjects
APIXABAN, ATRIAL fibrillation, ORAL medication, ISCHEMIC stroke, MEDICAL research, CONFIDENCE intervals
Abstract

Aim: To investigate the effects of off‐label non‐vitamin K oral anticoagulant (NOAC) dose reduction compared with on‐label standard dosing in atrial fibrillation (AF) patients in routine care. Methods: Population‐based cohort study using data from the United Kingdom Clinical Practice Research Datalink, comparing adults with non‐valvular AF receiving an off‐label reduced NOAC dose to patients receiving an on‐label standard dose. Outcomes were ischaemic stroke, major/non‐major bleeding and mortality. Inverse probability of treatment weighting and inverse probability of censoring weighting on the propensity score were applied to adjust for confounding and informative censoring. Results: Off‐label dose reduction occurred in 2466 patients (8.0%), compared with 18 108 (58.5%) on‐label standard‐dose users. Median age was 80 years (interquartile range [IQR] 73.0‐86.0) versus 72 years (IQR 66‐78), respectively. Incidence rates were higher in the off‐label dose reduction group compared to the on‐label standard dose group, for ischaemic stroke (0.94 vs 0.70 per 100 person years), major bleeding (1.48 vs 0.83), non‐major bleeding (6.78 vs 6.16) and mortality (10.12 vs 3.72). Adjusted analyses resulted in a hazard ratio of 0.95 (95% confidence interval [CI] 0.57‐1.60) for ischaemic stroke, 0.88 (95% CI 0.57‐1.35) for major bleeding, 0.81 (95% CI 0.67‐0.98) for non‐major bleeding and 1.34 (95% CI 1.12‐1.61) for mortality. Conclusion: In this large population‐based study, the hazards for ischaemic stroke and major bleeding were low, and similar in AF patients receiving an off‐label reduced NOAC dose compared with on‐label standard dose users, while non‐major bleeding risk appeared to be lower and mortality risk higher. Caution towards prescribing an off‐label reduced NOAC dose is therefore required. [ABSTRACT FROM AUTHOR]

Published
2023
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