Novel oral anticoagulant vs. warfarin in elderly atrial fibrillation patients with normal, mid‐range, and reduced left ventricular ejection fraction

Abstract

Aims Patients with concomitant atrial fibrillation (AF) and reduced left ventricular ejection fraction (LVEF) have poor prognosis. Outcomes of novel oral anticoagulant (NOAC) in elderly AF patients with normal, mid‐range, and reduced LVEF were investigated. Methods and results Data were retrieved from Chang Gung Research Database during 2010–2017 for patients with AF. We excluded patients with venous thromboembolism within 6 months, total knee/hip replacement and heart valve replacement within 6 months, end‐stage renal disease, stroke/systemic embolism (SE)/death within 7 days, age <65 years old, or no records of LVEF. Primary outcomes were ischaemic stroke (IS)/SE, major bleeding, and death from any cause. There was a total of 50 035 elderly AF patients retrieved. After exclusion criteria, 9615 patients with normal LVEF ≥ 50%, 737 with mid‐range LVEF 41–49%, and 908 with reduced LVEF ≤ 40% were studied. At end of follow‐up, patients on NOAC had significantly reduced IS/SE compared with warfarin in LVEF ≥ 50% [adjusted hazard ration (aHR) 0.80, 95% confidence interval (CI) 0.71–0.89] and LVEF 41–49% (aHR 0.57, 95% CI 0.36–0.88) after adjusting for covariates, while there was no difference in LVEF ≤ 40%. Patients on NOAC had significantly reduced major bleeding in all LVEF groups. In addition, patients on NOAC had significantly reduced death compared with warfarin in LVEF ≥ 50% (aHR 0.81, 95% CI 0.67–0.98). Conclusions In elderly AF patients ≥65 years, using NOAC was associated with lower IS/SE compared with warfarin in normal and mid‐range LVEF but not in reduced LVEF. Using NOACs was associated with lower death compared with warfarin in normal LVEF.