Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study.
Methods: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015).
Results: Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers.
Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.
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http://dx.doi.org/10.1177/1074248418769638 | DOI Listing |
Ann Med
December 2025
Heart Centre, Turku University Hospital, Turku, Finland.
Background: Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.
Materials And Methods: We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF.
Br J Hosp Med (Lond)
January 2025
The Cardiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Research evidence has demonstrated a significant association between hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), but the causality and pattern of this link remain unexplored. Therefore, this study investigated the causal relationship between HCM and AF using a two-sample and bidirectional Mendelian randomization (MR) approach. Additionally, this assessed the role of cardiovascular proteins (CPs) associated with cardiovascular diseases between HCM and AF by applying a two-step MR analysis.
View Article and Find Full Text PDFJ Clin Med
January 2025
Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy.
: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, occurring approximately in one-third of the patients. This study considered all-comer patients who underwent cardiac surgery to build a predictive model for POAF. : A total of 3467 (Center 1) consecutive patients were used as a derivation cohort to build the model.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. : We retrospectively analyzed ADHF patients with AF who were admitted to our institution from 2007 to 2017.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai 90110, Thailand.
Frailty is increasingly being recognized as a risk factor for adverse outcomes in older surgical patients undergoing surgery. We investigated the association between frailty and intraoperative complications using multiple frailty assessment tools in older patients undergoing elective intermediate- to high-risk non-cardiac surgery. This retrospective cohort study included 637 older patients scheduled for elective non-cardiac surgery.
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