Two-year outcomes of more than 30 000 elderly patients with atrial fibrillation: results from the All Nippon AF In the Elderly (ANAFIE) Registry

• Published in: European heart journal. Quality of care & clinical outcomes 2022-03, Vol.8 (2), p.202-213
• Main Authors: Yamashita, Takeshi, Suzuki, Shinya, Inoue, Hiroshi, Akao, Masaharu, Atarashi, Hirotsugu, Ikeda, Takanori, Okumura, Ken, Koretsune, Yukihiro, Shimizu, Wataru, Tsutsui, Hiroyuki, Toyoda, Kazunori, Hirayama, Atsushi, Yasaka, Masahiro, Yamaguchi, Takenori, Teramukai, Satoshi, Kimura, Tetsuya, Kaburagi, Jumpei, Takita, Atsushi
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Catheters; Humans; Male; Older people; Original; Prospective Studies; Registries; Stroke; Warfarin - therapeutic use
• ISSN: 2058-5225; 2058-1742
• DOI: 10.1093/ehjqcco/qcab025

Abstract Aims To clarify the real-world clinical status and prognosis of elderly and very elderly non-valvular atrial fibrillation (NVAF) patients, more than 30 000 elderly patients with NVAF aged ≥75 years were enrolled in the ANAFIE Registry. Methods and results This multicentre, prospective, observational study followed elderly NVAF patients in Japan for ∼2 years. Among 32 275 patients (mean age, 81.5 years; men, 57.3%; mean CHA2DS2-VASc score, 4.5), 2445 (7.6%) were not receiving oral anticoagulants (OACs) and 29 830 (92.4%) were given OACs. Of these, 21 585 (66.9%) were receiving direct OACs (DOACs) and 8233 (25.5%), warfarin (mean time in therapeutic range: ∼75%). In total, the 2-year incidence rate was 3.01% for stroke/systemic embolic events (SEE); 2.00%, major bleeding; and 6.95%, all-cause death. When compared with the warfarin group, the DOAC group had a lower hazard ratio (HR) for stroke/SEE, major bleeding, and all-cause death after adjusting for confounders. The group without OACs had a higher HR for stroke/SEE and all-cause death, with a lower HR for major bleeding. History of falls within 1 year at enrolment and of catheter ablation were positive and negative independent risk factors, respectively, for stroke/SEE, major bleeding, and all-cause death. Conclusion In Japan, a large proportion of elderly and very elderly NVAF patients were receiving DOACs, which was significantly associated with lower rates of stroke/SEE, major bleeding, and all-cause death vs. well-controlled warfarin. History of falls and of catheter ablation were independently associated with stroke/SEE, major bleeding, and all-cause death.