Management and Anticoagulation Treatment of Non-Valvular Atrial Fibrillation in Elderly Patients: The Dali Study

Figures & data

Table 1 Distribution of CHA₂DS₂-VASc Score and HAS-BLED Score in the NVAF Patients

	Total	Anticoagulant Therapy	Non-Anticoagulant Therapy	P
CHA2DS2-VASc-score≥2 and HAS-BLED score<3	94/155 (60.65%)	76/110 (69.09%)	18/45 (40.00%)	0.31
CHA2DS2-VASc-score≥2 and HAS-BLED score≥3	61/155 (39.35%)	39/110 (35.46%)	22/45 (48.89%)

Abbreviation: NVAF, non-valvular atrial fibrillation.

Table 2 Awareness and Treatment Rates of AF, Antiplatelet and Anticoagulant Use for NVAF Patients Upon Admission

	Total Number of Patients	N	Rate (%)
NVAF patients	155
Knowing about AF		81	52.26 (81/155)
Not knowing about AF		74	47.74 (74/155)
Anticoagulant therapy	34		21.94 (34/155)
Warfarin		10	29.41 (10/34)
NOACs		24	70.59 (24/34)
Rivaroxaban		23	95.83 (23/24)
Dabigatran		1	4.17 (1/24)
Antiplatelet therapy	18		11.61 (18/155)
Aspirin		14	77.78 (14/18)
Clopidogrel		3	16.67 (3/18)
Aspirin + Clopidogrel		1	5.56 (1/180)
Anticoagulant + Antiplatelet therapy	5		3.23 (5/155)
Radiofrequency ablation	1	1	0.65 (1/155)

Abbreviations: AF, atrial fibrillation; NVAF, non-valvular atrial fibrillation; NOACs, New oral anticoagulants.

Table 3 Rates of Antiplatelet and Anticoagulant Treatment at Discharge in NVAF Patients and Usage of NOACs

	Total Number of Patients	N	Rate (%)
Anticoagulant therapy	110		70.97 (110/155)
Warfarin		12	10.91 (12/110)
NOACs		98	89.09 (98/110)
Rivaroxaban		73	74.49 (73/98)
Edoxaban		25	25.51 (25/98)
Antiplatelet therapy	35		22.58 (35/155)
Aspirin		24	68.57 (24/35)
Clopidogrel		11	31.43 (11/35)
Anticoagulant + Antiplatelet therapy		11	7.10 (11/155)

Abbreviations: AF, atrial fibrillation; NVAF, non-valvular atrial fibrillation; NOACs, New oral anticoagulants.

Table 4 Factors Affecting Anticoagulant Therapy at Discharge in NVAF Patients

	Total Number of Patients	Anticoagulant Therapy	Non-Anticoagulant Therapy	t/χ^2	P
	N=155	N=110	N=45
Age, years	75.77±7.51	75.30±7.31	76.93±7.94	1.231	0.220
Men, n (%)	74/155 (47.74)	50/110 (45.45)	24/45 (53.33)	0.795	0.373
BMI, kg/m^2	23.21±3.62	22.99±3.66	23.91±3.48	1.212	0.228
Hypertension, n (%)	76/155 (49.03)	52/110 (47.27)	24/45 (53.33)	0.469	0.493
Diabetes, n (%)	21/155 (13.55)	16/110 (14.55)	5/45 (11.11)	0.322	0.571
CAD, n (%)	42/155 (27.10)	22/110 (20.00)	20/45 (44.44)	9.660	0.002
COPD, n (%)	60/155 (38.71)	41/110 (37.27)	19/45 (42.22)	0.330	0.566
Thromboembolism history, n (%)	20/155 (12.90)	19/110 (17.27)	1/45 (2.22)	5.167	0.023
Heart failure, n (%)	110/155 (70.90)	84/110 (76.36)	26/45 (57.78)	5.354	0.021
Stroke history, n (%)	13/155 (8.39)	8/110 (7.27)	5/45 (11.11)	0.612	0.434
Bleeding history, n (%)	22/155 (14.19)	7/110 (6.36)	15/45 (33.33)	19.073	<0.001
Antiplatelet therapy, n (%)	35/155 (22.58)	11/110 (10.00)	24/45 (53.33)	34.303	<0.001
Newly diagnosed AF, n (%)	81/155 (52.26)	55/110 (50.00)	26/45 (57.78)	0.774	0.379
Paroxysmal AF, n (%)	18/155 (11.61)	10/110 (9.09)	8/45 (17.78)	2.348	0.125
Persistent AF, n (%)	56/155 (36.13)	46/110 (41.82)	10/45 (22.22)	5.314	0.021
Smoking, n (%)	45/155 (29.03)	33/110 (30.00)	12/45 (26.67)	0.172	0.678
Drinking, n (%)	22/155 (14.19)	16/110 (14.55)	6/45 (13.33)	0.039	0.844
CHA2DS2-VASc score	5.26±1.55	5.33±1.51	5.09±1.66	−0.866	0.388
HAS-BLED score	2.28±1.10	2.17±1.08	2.56±1.12	1.979	0.05

Abbreviations: NVAF, non-valvular atrial fibrillation; BMI, body mass index; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; AF, atrial fibrillation.

Table 5 Multivariate Analysis of Predictors of Anticoagulant Therapy in NVAF Patients

	OR	95%Cl		P
		Lower	Upper
Men	0.232	0.061	0.880	0.032
≥75 years old	0.699	0.242	2.024	0.510
Hypertension	0.419	0.148	1.190	0.102
Diabetes	3.652	0.702	18.990	0.124
CAD	0.525	0.172	1.603	0.258
Heart failure	1.168	0.357	3.819	0.797
Stroke history	6.565	0.916	47.049	0.061
Bleeding history	0.014	0.002	0.098	<0.001
Thromboembolism history	70.014	3.220	1522.320	0.007
Antiplatelet therapy	0.048	0.013	0.168	<0.001
Persistent AF	4.052	1.172	14.007	0.027
Smoking	2.154	0.478	9.705	0.318
Drinking	1.338	0.247	7.244	0.735

Abbreviations: NVAF, non-valvular atrial fibrillation; CAD, coronary artery disease; AF, atrial fibrillation, Cl, confidence interval.

Figure 1 Reasons and Frequency for Non-Anticoagulant Therapy in NVAF Patients. The values presented in the figure are expressed as percentages (%).

Abbreviation: NVAF, non-valvular atrial fibrillation.

Table 6 Factors Affecting Anticoagulant Therapy in NVAF Patients One Year After Discharge

	Total Number of Patients	Anticoagulant Therapy	Non-Anticoagulant Therapy	t/χ^2	P
	N=102	N=53	N=49
Age, years	75.01±7.47	75.66±7.98	74.52±7.09	−0.839	0.403
Men, n (%)	44/102 (43.14)	21/53 (39.62)	23/49 (46.94)	0.556	0.456
BMI, kg/m^2	23.28±3.65	23.46±3.75	23.15±3.61	−0.427	0.670
Hypertension, n (%)	51/102 (50.00)	28/53 (52.83)	23/49 (46.94)	0.353	0.552
Diabetes, n (%)	16/102 (15.69)	8/53 (15.09)	8/49 (16.33)	0.029	0.864
CAD, n (%)	31/102 (30.39)	10/53 (18.87)	21/49 (42.86)	6.926	0.008
COPD, n (%)	38/102 (37.25)	23/53 (43.40)	15/49 (30.61)	1.780	0.182
Thromboembolism history, n (%)	14/102 (13.73)	13/53 (24.53)	1/49 (2.04)	9.057	0.003
Heart failure, n (%)	68/102 (66.67)	38/53 (71.70)	30/49 (61.22)	1.257	0.262
Stroke history, n (%)	12/102 (11.76)	10/53 (18.87)	2/49 (4.08)	4.033	0.045
Bleeding history, n (%)	14/102 (13.73)	3/53 (5.66)	11/49 (22.45)	4.725	0.030
Antiplatelet therapy when discharged, n (%)	21/102 (23.31)	7/53 (13.21)	14/49 (30.00)	3.676	0.055
Persistent AF, n (%)	35/102 (34.31)	26/53 (49.06)	9/49 (18.37)	10.639	0.001
Smoking, n (%)	29/102 (28.43)	12/53 (22.64)	17/49 (34.69)	1.818	0.178
Drinking, n (%)	16/102 (15.69)	5/53 (9.43)	11/49 (22.45)	3.261	0.071

Abbreviations: NVAF, non-valvular atrial fibrillation; BMI, body mass index; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; AF, atrial fibrillation.

Table 7 Cox Regression Analysis of Anticoagulant Therapy in NVAF Patients One Year After Discharge

	HR	95%Cl		P
		Lower	Upper
Age	1.063	1.013	1.115	0.012
Men	2.547	1.106	5.862	0.028
Hypertension	1.095	0.525	2.285	0.808
Diabetes	0.932	0.380	2.288	0.877
CAD	0.565	0.253	1.265	0.165
COPD	0.854	0.439	1.662	0.642
Stroke history	1.963	0.796	4.839	0.143
Bleeding history	0.235	0.056	0.981	0.047
Anticoagulant therapy when discharged	0.289	0.099	0.844	0.023
Thromboembolism history	3.220	1.326	7.820	0.010
Persistent AF	2.191	0.963	4.987	0.062
Antiplatelet therapy when discharged	0.319	0.105	0.972	0.044
Smoking	0.500	0.182	1.375	0.500
Drinking	0.721	0.216	2.407	0.595

Abbreviations: NVAF, non-valvular atrial fibrillation; CAD, coronary artery disease; COPD, chronic pulmonary disease; AF, atrial fibrillation; HR, hazard ratio; Cl, confidence interval.

Table 8 Cox Regression Analysis of All-Cause Mortality in NVAF Patients One Year After Discharge

	HR	95%Cl		P
		Lower	Upper
Age	1.057	1.005	1.111	0.031
Men	2.019	0.968	4.211	0.061
Hypertension	1.272	0.581	2.786	0.547
Diabetes	0.461	0.104	2.046	0.461
CAD	0.340	0.124	0.934	0.036
COPD	1.437	0.625	3.302	0.394
Stroke history	0.345	0.045	2.646	0.306
Bleeding history	1.311	0.504	3.412	0.579
Anticoagulant therapy when discharged	0.438	0.185	1.040	0.061
Persistent AF	1.424	0.609	3.328	0.414
NYHA IV	2.503	1.148	5.458	0.021

Abbreviations: NVAF, non-valvular atrial fibrillation; CAD, coronary artery disease; COPD, chronic pulmonary disease; AF, atrial fibrillation; NYHA IV, New York Heart Association functional classification class IV; HR, hazard ratio; Cl, confidence interval.