Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care
Abstract Aims Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assess...
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| Veröffentlicht in: | European heart journal. Cardiovascular pharmacotherapy 2023-01, Vol.9 (1), p.47-57 |
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| creator | Kirchhof, Paulus Pecen, Ladislav Bakhai, Ameet de Asmundis, Carlo de Groot, Joris R Deharo, Jean Claude Kelly, Peter Levy, Pierre Lopez-de-Sa, Esteban Monteiro, Pedro Steffel, Jan Waltenberger, Johannes Weiss, Thomas W Laeis, Petra Manu, Marius Constantin Souza, José De Caterina, Raffaele |
| description | Abstract
Aims
Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes.
Methods and results
The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P |
| doi_str_mv | 10.1093/ehjcvp/pvac042 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2694960937</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A758335950</galeid><oup_id>10.1093/ehjcvp/pvac042</oup_id><sourcerecordid>A758335950</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-4041e8b22a9c26d01f36e862e24fa19715f49291d9c4acab75e09acba88cb343</originalsourceid><addsrcrecordid>eNqFkc1r3DAQxU1oSUKaa4_F0Et7cKJPWzqGkLSFQC-5i7E8SrW1JVeyl_bUfz3a7jaBEig6SBr93mNGr6reUnJBieaX-G1jt_PlvAVLBDuqThmRsmmVkK-ezrw7qc5z3hBCaKtapvhxdcKlUlS03Wn1-2aIP6GHULuY6ryk-B3rOeEWw-JjqH2oYUkextr5PvlxhD9lCEMND9jAsFnzgsNOMni7xJTr6Go7-uBtEcV1sXHCvPNJ5eIDPj9aSPimeu1gzHh-2M-q-9ub--vPzd3XT1-ur-4aK1qxNIIIiqpnDLRl7UCo4y2WaZAJB1R3VDqhmaaDtgIs9J1EosH2oJTtueBn1Ye97ZzijxXzYiafLZZxAsY1G9Zqodvyp11B3_-DbuKaQmnOMMW4Eloy9kw9wIjGBxeXBHZnaq46qTiXWpJCXbxAlTXg5G0M6HypvySwKeac0Jk5-QnSL0OJ2WVu9pmbQ-ZF8O7Q7dpPODzhfxMuwMc9ENf5f2aP89u4VQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2823849522</pqid></control><display><type>article</type><title>Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>PubMed Central</source><creator>Kirchhof, Paulus ; Pecen, Ladislav ; Bakhai, Ameet ; de Asmundis, Carlo ; de Groot, Joris R ; Deharo, Jean Claude ; Kelly, Peter ; Levy, Pierre ; Lopez-de-Sa, Esteban ; Monteiro, Pedro ; Steffel, Jan ; Waltenberger, Johannes ; Weiss, Thomas W ; Laeis, Petra ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele</creator><creatorcontrib>Kirchhof, Paulus ; Pecen, Ladislav ; Bakhai, Ameet ; de Asmundis, Carlo ; de Groot, Joris R ; Deharo, Jean Claude ; Kelly, Peter ; Levy, Pierre ; Lopez-de-Sa, Esteban ; Monteiro, Pedro ; Steffel, Jan ; Waltenberger, Johannes ; Weiss, Thomas W ; Laeis, Petra ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele</creatorcontrib><description>Abstract
Aims
Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes.
Methods and results
The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P < 0.0001). Low kidney function at baseline was the strongest predictor of major bleeding (Wald χ2: 30.68; P < 0.0001). History of heart failure (HF) was the strongest predictor of all-cause (Wald χ2: 146.99; P < 0.0001) and cardiovascular death (Wald χ2: 100.38; P < 0.0001).
Conclusion
Patients treated with edoxaban in ETNA-AF-Europe reported low 2-year event rates in unselected AF patients. Prior stroke, reduced kidney function, and HF identify patients at high risk of stroke, bleeding and all-cause/cardiovascular death, respectively.
Graphical Abstract
Graphical Abstract
Age-adjusted predictors of clinical outcomes in the ETNA-AF-Europe Registry.</description><identifier>ISSN: 2055-6837</identifier><identifier>ISSN: 2055-6845</identifier><identifier>EISSN: 2055-6845</identifier><identifier>DOI: 10.1093/ehjcvp/pvac042</identifier><identifier>PMID: 35881467</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - adverse effects ; Atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Brain Ischemia - prevention & control ; Cardiac arrhythmia ; Care and treatment ; Clinical outcomes ; Embolism ; Factor Xa Inhibitors ; Female ; Heart Failure - drug therapy ; Hemorrhage - chemically induced ; Humans ; Ischemia ; Male ; Medical equipment and supplies industry ; Medical research ; Medical test kit industry ; Medicine, Experimental ; Middle Aged ; Patient outcomes ; Pharmaceutical industry ; Prevention ; Prospective Studies ; Stroke ; Stroke (Disease) ; Stroke - diagnosis ; Stroke - epidemiology ; Stroke - prevention & control ; Treatment Outcome</subject><ispartof>European heart journal. Cardiovascular pharmacotherapy, 2023-01, Vol.9 (1), p.47-57</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><rights>COPYRIGHT 2023 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-4041e8b22a9c26d01f36e862e24fa19715f49291d9c4acab75e09acba88cb343</citedby><cites>FETCH-LOGICAL-c464t-4041e8b22a9c26d01f36e862e24fa19715f49291d9c4acab75e09acba88cb343</cites><orcidid>0000-0002-2417-9880 ; 0000-0002-1881-0197 ; 0000-0002-1477-9153 ; 0000-0001-9827-3178 ; 0000-0003-1637-574X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35881467$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirchhof, Paulus</creatorcontrib><creatorcontrib>Pecen, Ladislav</creatorcontrib><creatorcontrib>Bakhai, Ameet</creatorcontrib><creatorcontrib>de Asmundis, Carlo</creatorcontrib><creatorcontrib>de Groot, Joris R</creatorcontrib><creatorcontrib>Deharo, Jean Claude</creatorcontrib><creatorcontrib>Kelly, Peter</creatorcontrib><creatorcontrib>Levy, Pierre</creatorcontrib><creatorcontrib>Lopez-de-Sa, Esteban</creatorcontrib><creatorcontrib>Monteiro, Pedro</creatorcontrib><creatorcontrib>Steffel, Jan</creatorcontrib><creatorcontrib>Waltenberger, Johannes</creatorcontrib><creatorcontrib>Weiss, Thomas W</creatorcontrib><creatorcontrib>Laeis, Petra</creatorcontrib><creatorcontrib>Manu, Marius Constantin</creatorcontrib><creatorcontrib>Souza, José</creatorcontrib><creatorcontrib>De Caterina, Raffaele</creatorcontrib><title>Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care</title><title>European heart journal. Cardiovascular pharmacotherapy</title><addtitle>Eur Heart J Cardiovasc Pharmacother</addtitle><description>Abstract
Aims
Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes.
Methods and results
The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P < 0.0001). Low kidney function at baseline was the strongest predictor of major bleeding (Wald χ2: 30.68; P < 0.0001). History of heart failure (HF) was the strongest predictor of all-cause (Wald χ2: 146.99; P < 0.0001) and cardiovascular death (Wald χ2: 100.38; P < 0.0001).
Conclusion
Patients treated with edoxaban in ETNA-AF-Europe reported low 2-year event rates in unselected AF patients. Prior stroke, reduced kidney function, and HF identify patients at high risk of stroke, bleeding and all-cause/cardiovascular death, respectively.
Graphical Abstract
Graphical Abstract
Age-adjusted predictors of clinical outcomes in the ETNA-AF-Europe Registry.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - adverse effects</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Brain Ischemia - prevention & control</subject><subject>Cardiac arrhythmia</subject><subject>Care and treatment</subject><subject>Clinical outcomes</subject><subject>Embolism</subject><subject>Factor Xa Inhibitors</subject><subject>Female</subject><subject>Heart Failure - drug therapy</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical equipment and supplies industry</subject><subject>Medical research</subject><subject>Medical test kit industry</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Patient outcomes</subject><subject>Pharmaceutical industry</subject><subject>Prevention</subject><subject>Prospective Studies</subject><subject>Stroke</subject><subject>Stroke (Disease)</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><subject>Stroke - prevention & control</subject><subject>Treatment Outcome</subject><issn>2055-6837</issn><issn>2055-6845</issn><issn>2055-6845</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkc1r3DAQxU1oSUKaa4_F0Et7cKJPWzqGkLSFQC-5i7E8SrW1JVeyl_bUfz3a7jaBEig6SBr93mNGr6reUnJBieaX-G1jt_PlvAVLBDuqThmRsmmVkK-ezrw7qc5z3hBCaKtapvhxdcKlUlS03Wn1-2aIP6GHULuY6ryk-B3rOeEWw-JjqH2oYUkextr5PvlxhD9lCEMND9jAsFnzgsNOMni7xJTr6Go7-uBtEcV1sXHCvPNJ5eIDPj9aSPimeu1gzHh-2M-q-9ub--vPzd3XT1-ur-4aK1qxNIIIiqpnDLRl7UCo4y2WaZAJB1R3VDqhmaaDtgIs9J1EosH2oJTtueBn1Ye97ZzijxXzYiafLZZxAsY1G9Zqodvyp11B3_-DbuKaQmnOMMW4Eloy9kw9wIjGBxeXBHZnaq46qTiXWpJCXbxAlTXg5G0M6HypvySwKeac0Jk5-QnSL0OJ2WVu9pmbQ-ZF8O7Q7dpPODzhfxMuwMc9ENf5f2aP89u4VQ</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Kirchhof, Paulus</creator><creator>Pecen, Ladislav</creator><creator>Bakhai, Ameet</creator><creator>de Asmundis, Carlo</creator><creator>de Groot, Joris R</creator><creator>Deharo, Jean Claude</creator><creator>Kelly, Peter</creator><creator>Levy, Pierre</creator><creator>Lopez-de-Sa, Esteban</creator><creator>Monteiro, Pedro</creator><creator>Steffel, Jan</creator><creator>Waltenberger, Johannes</creator><creator>Weiss, Thomas W</creator><creator>Laeis, Petra</creator><creator>Manu, Marius Constantin</creator><creator>Souza, José</creator><creator>De Caterina, Raffaele</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2417-9880</orcidid><orcidid>https://orcid.org/0000-0002-1881-0197</orcidid><orcidid>https://orcid.org/0000-0002-1477-9153</orcidid><orcidid>https://orcid.org/0000-0001-9827-3178</orcidid><orcidid>https://orcid.org/0000-0003-1637-574X</orcidid></search><sort><creationdate>20230101</creationdate><title>Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care</title><author>Kirchhof, Paulus ; Pecen, Ladislav ; Bakhai, Ameet ; de Asmundis, Carlo ; de Groot, Joris R ; Deharo, Jean Claude ; Kelly, Peter ; Levy, Pierre ; Lopez-de-Sa, Esteban ; Monteiro, Pedro ; Steffel, Jan ; Waltenberger, Johannes ; Weiss, Thomas W ; Laeis, Petra ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-4041e8b22a9c26d01f36e862e24fa19715f49291d9c4acab75e09acba88cb343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - adverse effects</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Brain Ischemia - prevention & control</topic><topic>Cardiac arrhythmia</topic><topic>Care and treatment</topic><topic>Clinical outcomes</topic><topic>Embolism</topic><topic>Factor Xa Inhibitors</topic><topic>Female</topic><topic>Heart Failure - drug therapy</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical equipment and supplies industry</topic><topic>Medical research</topic><topic>Medical test kit industry</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Patient outcomes</topic><topic>Pharmaceutical industry</topic><topic>Prevention</topic><topic>Prospective Studies</topic><topic>Stroke</topic><topic>Stroke (Disease)</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><topic>Stroke - prevention & control</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirchhof, Paulus</creatorcontrib><creatorcontrib>Pecen, Ladislav</creatorcontrib><creatorcontrib>Bakhai, Ameet</creatorcontrib><creatorcontrib>de Asmundis, Carlo</creatorcontrib><creatorcontrib>de Groot, Joris R</creatorcontrib><creatorcontrib>Deharo, Jean Claude</creatorcontrib><creatorcontrib>Kelly, Peter</creatorcontrib><creatorcontrib>Levy, Pierre</creatorcontrib><creatorcontrib>Lopez-de-Sa, Esteban</creatorcontrib><creatorcontrib>Monteiro, Pedro</creatorcontrib><creatorcontrib>Steffel, Jan</creatorcontrib><creatorcontrib>Waltenberger, Johannes</creatorcontrib><creatorcontrib>Weiss, Thomas W</creatorcontrib><creatorcontrib>Laeis, Petra</creatorcontrib><creatorcontrib>Manu, Marius Constantin</creatorcontrib><creatorcontrib>Souza, José</creatorcontrib><creatorcontrib>De Caterina, Raffaele</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Cardiovascular pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirchhof, Paulus</au><au>Pecen, Ladislav</au><au>Bakhai, Ameet</au><au>de Asmundis, Carlo</au><au>de Groot, Joris R</au><au>Deharo, Jean Claude</au><au>Kelly, Peter</au><au>Levy, Pierre</au><au>Lopez-de-Sa, Esteban</au><au>Monteiro, Pedro</au><au>Steffel, Jan</au><au>Waltenberger, Johannes</au><au>Weiss, Thomas W</au><au>Laeis, Petra</au><au>Manu, Marius Constantin</au><au>Souza, José</au><au>De Caterina, Raffaele</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care</atitle><jtitle>European heart journal. Cardiovascular pharmacotherapy</jtitle><addtitle>Eur Heart J Cardiovasc Pharmacother</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>9</volume><issue>1</issue><spage>47</spage><epage>57</epage><pages>47-57</pages><issn>2055-6837</issn><issn>2055-6845</issn><eissn>2055-6845</eissn><abstract>Abstract
Aims
Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes.
Methods and results
The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P < 0.0001). Low kidney function at baseline was the strongest predictor of major bleeding (Wald χ2: 30.68; P < 0.0001). History of heart failure (HF) was the strongest predictor of all-cause (Wald χ2: 146.99; P < 0.0001) and cardiovascular death (Wald χ2: 100.38; P < 0.0001).
Conclusion
Patients treated with edoxaban in ETNA-AF-Europe reported low 2-year event rates in unselected AF patients. Prior stroke, reduced kidney function, and HF identify patients at high risk of stroke, bleeding and all-cause/cardiovascular death, respectively.
Graphical Abstract
Graphical Abstract
Age-adjusted predictors of clinical outcomes in the ETNA-AF-Europe Registry.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35881467</pmid><doi>10.1093/ehjcvp/pvac042</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-2417-9880</orcidid><orcidid>https://orcid.org/0000-0002-1881-0197</orcidid><orcidid>https://orcid.org/0000-0002-1477-9153</orcidid><orcidid>https://orcid.org/0000-0001-9827-3178</orcidid><orcidid>https://orcid.org/0000-0003-1637-574X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2055-6837 |
| ispartof | European heart journal. Cardiovascular pharmacotherapy, 2023-01, Vol.9 (1), p.47-57 |
| issn | 2055-6837 2055-6845 2055-6845 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2694960937 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); PubMed Central |
| subjects | Aged Aged, 80 and over Anticoagulants Anticoagulants - adverse effects Atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Brain Ischemia - prevention & control Cardiac arrhythmia Care and treatment Clinical outcomes Embolism Factor Xa Inhibitors Female Heart Failure - drug therapy Hemorrhage - chemically induced Humans Ischemia Male Medical equipment and supplies industry Medical research Medical test kit industry Medicine, Experimental Middle Aged Patient outcomes Pharmaceutical industry Prevention Prospective Studies Stroke Stroke (Disease) Stroke - diagnosis Stroke - epidemiology Stroke - prevention & control Treatment Outcome |
| title | Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T00%3A01%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Edoxaban%20for%20stroke%20prevention%20in%20atrial%20fibrillation%20and%20age-adjusted%20predictors%20of%20clinical%20outcomes%20in%20routine%20clinical%20care&rft.jtitle=European%20heart%20journal.%20Cardiovascular%20pharmacotherapy&rft.au=Kirchhof,%20Paulus&rft.date=2023-01-01&rft.volume=9&rft.issue=1&rft.spage=47&rft.epage=57&rft.pages=47-57&rft.issn=2055-6837&rft.eissn=2055-6845&rft_id=info:doi/10.1093/ehjcvp/pvac042&rft_dat=%3Cgale_proqu%3EA758335950%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2823849522&rft_id=info:pmid/35881467&rft_galeid=A758335950&rft_oup_id=10.1093/ehjcvp/pvac042&rfr_iscdi=true |