Oral anticoagulation in heart failure complicated by atrial fibrillation: A nationwide routine data study.

Background: This nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints.
Methods: Anonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017-2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91-365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome.
Results: 180,316 cases were included [81 years (IQR 76-86), 55.6% female, CHA ₂ DS ₂ -VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75-0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71-0.76]; FXaI: HR 0.77, [0.75-0.78]; DTI: HR 0.71, [0.66-0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65-0.77]) was lower with OAC.
Conclusions: Nationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority.
Competing Interests: Declaration of Competing Interest M.M. received speakers and consulting fees from Bayer Healthcare, BMS, Boehringer Ingelheim, Daiichi Sankyo, Astra Zeneca, Sanofi, BRAHMS GmbH and Roche Diagnostics as well as research funding from German public funding authorities for Health Care Research and Roche Diagnostics; G.M. received speaker fees from Getinge, Orion Pharma and AOP Orphan Pharmaceuticals Germany GmbH; no other relationships or activities that could appear to have influenced the submitted work.
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