Effect of oral anti-coagulant on 12-month overall mortality rate in admitted elderly patient with newly diagnosed atrial fibrillation and atrial flutter
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Abstract
Background: Atrial fibrillation increases the risk of ischemic stroke, contributing to increased disability and mortality. Nevertheless, the benefit of early initiation of oral anticoagulant (OAC) for stroke prevention in elderly with newly diagnosed atrial fibrillation (AF) during hospitalization for non-cardiac causes remains questionable.
Objective: To study the effect of OAC on the 12-month overall mortality rate in admitted elderly patient with newly diagnosed atrial fibrillation and atrial flutter
Methods: We conducted a retrospective cohort study involving hospitalized patients with non-cardiac causes at Siriraj Hospital in Thailand between 2003-2019. Participants aged more than 75 years and newly diagnosed AF were included. The primary outcome was overall mortality. Secondary outcomes were cardiovascular death, non-cardiovascular death, non-fatal stroke, bleeding events, and rehospitalization.
Results: We enrolled a total of 216 participants, with 24 in the OAC group and 192 in the non-OAC group. The predominant OAC used was warfarin (91.7%). Throughout the 1-year follow-up period, 6 deaths were observed in the OAC group, compared to 107 deaths in the non-OAC group. The hazard ratio (HR) for overall mortality was 0.33 (95% confidence interval [CI], 0.15-0.75; p-value = 0.08). Post-hoc power was 84% with an alpha of 0.05. However, non-cardiovascular deaths accounted for 96.4% of all deaths. There were 4 non-fatal strokes only in the non-OAC group. The HR for bleeding events was 6.11 (95% CI, 1.37-27.32; p-value = 0.018).
Conclusions: Non-cardiovascular death emerged as the primarily cause of death. The potential benefits of initiating OAC in elderly patients newly diagnosed with AF during hospitalization might be constrained by patients' active medical conditions. Nevertheless, the consideration of stroke prevention post-hospitalization in elderly remains warranted. Further prospective studies are required to determine the optimal timing for initiating OAC therapy, mainly warfarin to maximize the benefit of stroke prevention while minimizing bleeding risks.
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