Stroke Incidence and Death in Atrial Fibrillation Patients Newly Treated with Direct Oral Anticoagulants
Received 5 November 2020
Accepted for publication 8 January 2021
Published 19 February 2021 Volume 2021:13 Pages 131—140
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Henrik Toft Sørensen
Amélie Gabet,1 Edouard Chatignoux,1 Clémence Grave,1 Alexandre Vallée,2 Philippe Tuppin,3 Yannick Béjot,4 Valérie Olié1
1French Public Health Agency, Saint-Maurice, France; 2Diagnosis and Therapeutic Center, Hotel Dieu, AP-HP, University Paris Descartes, Paris, France; 3General Health Insurance Scheme (Caisse Nationale d’Assurance Maladie), Paris, France; 4Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France
Correspondence: Amélie Gabet
French Public Health Agency, 14 rue du Val d’Osne, Saint Maurice, 94410, France
Purpose: The objectives were to analyse the determinants of stroke incidence and mortality as a competing event in AF patients newly treated with DOAC and to assess the impact of non-adherence to DOAC treatment.
Methods: It is a population-based retrospective cohort study using the French national healthcare data system. AF patients aged > 20 years were affiliated to the general health insurance scheme (66% of the French population) and newly treated with DOAC between 2012 and 2015 were included and followed for 2 years.
Results: Overall 76,795 AF patients were newly treated with DOAC in 2015. Stroke incidence reached 10.1 (95% CI: 9.6– 10.6) per 1000 person-year and death 39.7 (95% CI: 38.6– 40.8) as a competitive risk. Female sex was associated with a lower risk of death but not of stroke. Non-adherence to DOAC treatment increased the risk of both stroke (42%) and death (38%). Acute coronary syndrome was associated with an increased risk of stroke alone, whereas heart failure decompensation, social deprivation, and haemorrhage were associated with an increased risk of death alone.
Conclusion: Both stroke and death risks remain non-negligible in AF patients treated with DOAC. Non-adherence was associated with an increased risk of stroke and death.
Keywords: atrial fibrillation, stroke, death, adherence, direct oral anticoagulants
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