Savarese G, et al. - Prevalence of, predictors of and consequences of oral anticoagulants (OAC) non-use were investigated in patients with atrial fibrillation (AF) and concomitant heart failure (HF). Findings showed that these patients did not receive OAC on rational grounds. Researchers found that in this patient population, decision-making was inappropriately influenced by bleeding risk more than stroke risk.

Methods

• Using the Swedish Heart Failure Registry, patients with AF, HF and no previous valve replacement were identified and included in this study.
• High and low CHA₂DS₂-VASc and HAS-BLED scores were defined as above/below median.
• Researchers used multivariable logistic regressions to assess the links between baseline characteristics and OAC use and between CHA₂DS₂-VASc and HAS-BLED scores and OAC use.
• Furthermore, they used multivariable Cox regressions to assess links between CHA₂DS₂-VASc and HAS-BLED scores, OAC use and two composite outcomes: all-cause death/stroke and all-cause death/major bleeding.

Results

• Receipt of OAC was reported in 12,659 (58%) of a total of 21,865 patients.
• The following were identified as selected predictors of OAC non-use: treatment with platelet inhibitors, less use of HF treatments, paroxysmal AF, history of bleeding, no previous stroke, planned follow-up in primary care, older age, living alone, lower income and variables associated with more severe HF.
• Findings demonstrated that for each 1-unit increase in CHA₂DS₂-VASc and HAS-BLED, the ORs (95% CI) of OAC use were 1.24 (1.21–1.27) and 0.32 (0.30–0.33), and the HRs for death/stroke were 1.08 (1.06–1.10) and for death/major bleeding 1.18 (1.15–1.21), respectively.
• Researchers found that for high vs low CHA₂DS₂-VASc and HAS-BLED, the ORs of OAC use were 1.23 (1.15–1.32) and 0.20 (0.19–0.21), and the HRs for death/stroke were 1.25 (1.19–1.30) and for death/major bleeding 1.28 (1.21–1.34), respectively.