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      New Oral Anticoagulants vs Vitamin K Antagonists: Benefits for Health-Related Quality of Life in Patients with Atrial Fibrillation

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          Abstract

          New oral anticoagulants (NOAC) have demonstrated their efficacy as an alternative to vitamin K antagonists (VKA) in the prophylaxis of cardioembolic events in patients with atrial fibrillation (AF). However, evidence on the benefits of NOAC in health-related quality of life (HRQoL) is lacking.We evaluated changes in HRQoL related to oral anticoagulation therapy employing a specific questionnaire in a cohort of 416 patients with AF undergoing electrical cardioversion. In terms of HRQoL, we observed a progressive adaptation to treatment with VKA; satisfaction with NOAC remained constant. Older age, higher left ventricular ejection fraction and NOAC were associated with better HRQoL.

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          Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation.

          Elaine Hylek, Carmella Evans-Molina, Carol Shea … (2007)
          Warfarin is effective in the prevention of stroke in atrial fibrillation but is under used in clinical care. Concerns exist that published rates of hemorrhage may not reflect real-world practice. Few patients > or = 80 years of age were enrolled in trials, and studies of prevalent use largely reflect a warfarin-tolerant subset. We sought to define the tolerability of warfarin among an elderly inception cohort with atrial fibrillation. Consecutive patients who started warfarin were identified from January 2001 to June 2003 and followed for 1 year. Patients had to be > or = 65 years of age, have established care at the study institution, and have their warfarin managed on-site. Outcomes included major hemorrhage, time to termination of warfarin, and reason for discontinuation. Of 472 patients, 32% were > or = 80 years of age, and 91% had > or = 1 stroke risk factor. The cumulative incidence of major hemorrhage for patients > or = 80 years of age was 13.1 per 100 person-years and 4.7 for those or = 80 years, and international normalized ratio (INR) > or = 4.0 were associated with increased risk despite trial-level anticoagulation control. Within the first year, 26% of patients > or = 80 years of age stopped taking warfarin. Perceived safety issues accounted for 81% of them. Rates of major hemorrhage and warfarin termination were highest among patients with CHADS2 scores (an acronym for congestive heart failure, hypertension, age > or = 75, diabetes mellitus, and prior stroke or transient ischemic attack) of > or = 3. Rates of hemorrhage derived from younger noninception cohorts underestimate the bleeding that occurs in practice. This finding coupled with the short-term tolerability of warfarin likely contributes to its underutilization. Stroke prevention among elderly patients with atrial fibrillation remains a challenging and pressing health concern.
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            Long-term quality of life after ablation of atrial fibrillation the impact of recurrence, symptom relief, and placebo effect.

            Anita Wokhlu, Kristi Monahan, David Hodge … (2010)
            We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years. Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term. A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms. In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 +/- 20.1 to 76.2 +/- 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 +/- 18.6 to 79.8 +/- 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 +/- 19.7 and change in mental component summary: 9.7 +/- 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 +/- 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 +/- 3.8, p = 0.03) or those with recurrent AF (-3.4 +/- 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up. AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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              Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial.

              Jonathan P. Piccini, Susanna R Stevens, Yuliya Lokhnygina … (2013)
              This study sought to investigate the outcomes following cardioversion or catheter ablation in patients with atrial fibrillation (AF) treated with warfarin or rivaroxaban.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Med Sci
                Journal ID (iso-abbrev): Int J Med Sci
                Journal ID (publisher-id): ijms
                Title: International Journal of Medical Sciences
                Publisher: Ivyspring International Publisher (Sydney )
                ISSN (Electronic): 1449-1907
                Publication date Collection: 2014
                Publication date (Electronic): 1 May 2014
                Volume: 11
                Issue: 7
                Pages: 680-684
                Affiliations
                1. Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain.
                2. Hospital de la Sta. Creu i St. Pau, Barcelona, Spain.
                3. Hospital Virgen de la Salud, Toledo, Spain.
                4. Hospital Universitari Parc Taulí, Sabadell, Spain.
                5. LA-SER Outcomes, Oviedo, Spain.
                6. Medical Department, Bayer HealthCare, Barcelona, Spain.
                7. Hospital Clínico, Santiago de Compostela, Spain.
                Author notes
                ✉ Corresponding author: Josep M Alegret, Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, Departament de Medicina i Cirurgia, Universitat Rovira i Virgili. c/ Dr Josep Laporte, nº1, 43204 Reus. Email: josepmaria.alegret@ 123456urv.net .

                Competing Interests: This study was funded by Bayer Health Care, Spain.

                JMA has not added conflict of interest to declare. XV has exerted as consultant for Bayer. MAA has participated in conferences for Bayer. AM-R has received research grants, and has participated in advisory boards and conferences for Bayer, Boehringer Ingelheim and Pfizer. PR has not added conflict of interest to declare. CR is employee of Bayer.

                Article
                Publisher ID: ijmsv11p0680
                DOI: 10.7150/ijms.8916
                PMC ID: 4025166
                SO-VID: 8443ae3f-957a-424c-8450-1fe64a8c98c5
                Copyright © © Ivyspring International Publisher. This is an open-access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited.
                History
                Date received : 24 February 2014
                Date accepted : 1 April 2014
                Categories
                Subject: Research Paper

                ScienceOpen disciplines: Medicine
                Keywords: vitamin k antagonists,dabigatran,health-related quality of life,new oral anticoagulants,ribaroxaban.
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: vitamin k antagonists, dabigatran, health-related quality of life, new oral anticoagulants, ribaroxaban.

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