Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study
Main finding · Newly diagnosed HFResult — go to the resultHazard ratio 0.80 95% CI 0.74–0.86Authors' conclusion
This nationwide cohort study demonstrated that elderly patients with AF and DM taking NOACs had a lower risk of incident HF than those taking warfarin. Our findings suggested that NOACs may be the preferred oral anticoagulant treatment when considering the prevention of heart failure in this vulnerable population. Future research is warranted to elucidate causation and investigate the underlying mechanisms.
Study context
- Population
- Patients aged ≥ 65 years with atrial fibrillation (AF) and diabetes mellitus (DM) on NOAC or warfarin treatment between 2012 and 2019, followed up until 2020; Taiwanese nationwide claims data
- Participants
- 24,835 patients
- Exposure
- NOACs vs warfarin
- NOACn = 19,710
- Warfarinn = 5,125reference
- Outcome
- Newly diagnosed HF
Methodological detailsnationwide, target trial emulation, propensity score-based fine stratification weighting
- Nationwide
- Target trial emulation
- Propensity score-based fine stratification weighting
Main finding
As reported in the abstract
Hazard ratio
0.80
95% CI 0.74–0.86
P < 0.001
NOACvs Warfarin
HR 0.80 (95% CI 0.74–0.86); P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF by individual NOAC (subgroup analyses)Dabigatranvs Warfarin | 0.86 (0.80–0.93) | P < 0.001 | |
| HF by individual NOAC (subgroup analyses)Rivaroxabanvs Warfarin | 0.80 (0.74–0.86) | P < 0.001 | |
| HF by individual NOAC (subgroup analyses)Apixabanvs Warfarin | 0.78 (0.68–0.90) | P < 0.001 | |
| HF by individual NOAC (subgroup analyses)Edoxabanvs Warfarin | 0.72 (0.60–0.86) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Heart failure (HF) by age, sex and medication possession ratio subgroups
- Consistent regardless of age and sex subgroups; more prominent with high medication possession ratios
Original publication
Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study. Cardiovasc Diabetol. Published 6 January 2023. doi:10.
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