ArticleEuropean heart journal. Quality of care & clinical outcomes2024
Impact of frailty on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a nationwide cohort study.
Article in European heart journal. Quality of care & clinical outcomes, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Impact of frailty on outcomes in atrial fibrillation and HFpEF: data from the TOPCAT trial.BMC cardiovascular disorders · 2026Trial
- Navigating Anticoagulation Decisions in Atrial Fibrillation and Frailty Comorbidity.Life (Basel, Switzerland) · 2026Review
- Comparative Effectiveness of Oral Anticoagulants and Home Time After Venous Thromboembolism in Frail and Non-Frail Older Adults.American journal of hematology · 2026Article
- Outcomes of individual DOACs vs. VKAs in AF patients with frailty: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Interactions Between Direct Oral Anticoagulants and Drugs Involving CYP-Enzymes and P-gp Transporters Detected by a Clinical Decision Support System: A Retrospective Cohort Study.Cardiovascular drugs and therapy · 2026Article
- Real-life impact of anti-IL5 therapy on exacerbation types in patients with obstructive lung disease.BMJ open respiratory research · 2025Article
- Predictors of mortality and hospitalised exacerbations in obstructive airway diseases.ERJ open research · 2025Article
- Impact of frailty on outcomes of elderly patients with atrial fibrillation: A systematic review and meta-analysis.Pakistan journal of medical sciences · 2025Review
- Poor clinical outcomes associated to multimorbidity, frailty and malnutrition in patients with atrial fibrillation.The journal of nutrition, health & aging · 2025Observational
- Anticoagulant-related bleeding as a sign of underlying tumoural lesions in patients with atrial fibrillation: a nationwide cohort study.European heart journal open · 2024Article
- [Drug therapy for arterial hypertension and atrial fibrillation in frail patients : Are there any new insights and recommendations?]Innere Medizin (Heidelberg, Germany) · 2024Review
- Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants.JAMA network open · 2023Article
- Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Review
- Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study.International journal of cardiology. Heart & vasculature · 2023Article
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Authors and funding
5 authors.
Funding
Abstract
aimsData on non-vitamin K antagonist oral anticoagulants (NOACs) use in patients with atrial fibrillation (AF) and frailty are scarce. Therefore, the impact of frailty on AF-related outcomes and benefit-risk profiles of NOACs in patients with frailty were investigated. METHODS AND
resultsAF patients initiating anticoagulation between 2013 and 2019 were included using Belgian nationwide data. Frailty was assessed with the Claims-based Frailty Indicator. Among 254 478 anticoagulated AF patients, 71 638 (28.2%) had frailty. Frailty was associated with higher all-cause mortality risks [adjusted hazard ratio (aHR) 1.48, 95% confidence interval (CI) (1.43-1.54)], but not with thromboembolism or bleeding. Among subjects with frailty (78 080 person-years of follow-up), NOACs were associated with lower risks of stroke or systemic embolism (stroke/SE) [aHR 0.77, 95%CI (0.70-0.86)], all-cause mortality [aHR 0.88, 95%CI (0.84-0.92)], and intracranial bleeding [aHR 0.78, 95%CI (0.66-0.91)], a similar major bleeding risk [aHR 1.01, 95%CI (0.93-1.09)], and higher gastrointestinal bleeding risk [aHR 1.19, 95%CI (1.06-1.33)] compared with VKAs. Major bleeding risks were lower with apixaban [aHR 0.84, 95%CI (0.76-0.93)], similar with edoxaban [aHR 0.91, 95%CI (0.73-1.14)], and higher with dabigatran [aHR 1.16, 95%CI (1.03-1.30)] and rivaroxaban [aHR 1.11, 95%CI (1.02-1.21)] compared with VKAs. Apixaban was associated with lower major bleeding risks compared with dabigatran [aHR 0.72, 95%CI (0.65-0.80)], rivaroxaban [aHR 0.78, 95%CI (0.72-0.84)] and edoxaban [aHR 0.74, 95%CI (0.65-0.84)], but mortality risk was higher compared with dabigatran and edoxaban.
conclusionFrailty was an independent risk factor of death. Non-vitamin K antagonist oral anticoagulants had better benefit-risk profiles than VKAs in patients with frailty, especially apixaban, followed by edoxaban.
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