Mortality on DOACs Versus on Vitamin K Antagonists in Atrial Fibrillation: Analysis of the Hungarian Health Insurance Fund Database.

Purpose: Limited real-world data are available on the survival of patients treated with vitamin K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention to the early treatment period.
Methods: The Hungarian National Health Insurance Fund (NHIF) database was searched to identify patients treated with VKA or DOAC as a thromboembolic prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0-3, 4-6, and 7-12 months) mortality risks with the 2 types of anticoagulation were compared. A total of 144,394 patients with AF treated with either a VKA (n = 129,925) or a DOAC (n = 14,469) were enrolled.
Findings: A 28% improvement in 3-year survival with DOAC treatment compared with VKA treatment was shown. Mortality reduction with DOACs was consistent across different subgroups. However, younger patients (30-59 years old) initiated on DOAC therapy had the greatest RRR (53%) in mortality. Furthermore, DOAC treatment also yielded a benefit of greater magnitude (HR = 0.55; 95% CI, 0.40-0.77, P = 0.001) in the lower (0-1) CHA ₂ DS ₂ -VASc score segment and in those with fewer (0-1) bleeding risk factors (HR = 0.50, CI 0.34-0.73, P = 0.001). The RRR in mortality with DOACs was 33% within the first 3 months, and 6% in the second year.
Implications: Thromboembolic prophylaxis with DOACs in this study yielded significantly lower mortality compared with VKA treatment in patients with nonvalvular AF. The largest benefit was shown in the early period after treatment initiation, as well as in younger patients, those with a lower CHA ₂ DS ₂ -VASc score, and those with fewer bleeding risk factors.
Competing Interests: Declaration of Interest Dr Rokszin and Ms Fábián were employed by RxTarget Ltd. Their contribution to this study analysis was financially compensated by the Hungarian Society of Cardiology. Dr Becker reports personal fees from Novo Nordisk, Richter Gedeon Nyrt, and TEVA. Dr Aradi reports lecture fees from Bayer AG, Pfizer, Boehringer Ingelheim, and MSD Pharma. Dr Merkely reports grants or contracts from Medtronic and Boston Scientific; and personal fees from Biotronik and Abbott. Dr Járai reports support for attending meetings from Egis and Pfizer; advisory board membership at Bayer, Berlin Chemie, KRKA, Novartis, Novo Nordisk, Pfizer, Sanofi, and TEVA; and board membership at the Hungarian Society of Hypertension, Hungarian Society of Cardiology, Hungarian Society of Angiology and Vascular Surgery, and Hungarian Society of Experimental and Clinical Pharmacology. The authors have indicated that they have no other conflicts of interest regarding the content of this article.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)