Direct Oral Anti-coagulation Significantly Reduces Mortality in Atrial Fibrillation

Introduction: Direct anticoagulants (DOACs) have demonstrated significant reduction in stroke and all-cause mortality rates in non-valvular atrial fibrillation (NVAF) patients. However, utilization of DOACs is still limited, with many patients not receiving any anticoagulation therapy. Data on long-term mortality implications of DOAC underutilization in the general NVAF population is limited. Our objective was to explore the effect of DOACs on mortality of NVAF patients in a clinical practice setting with long-term follow-up.
Hypothesis: We assessed the hypothesis that DOAC therapy significantly reduces mortality in eligible NVAF patients.
Methods: We identified all NVAF patients eligible by Israel guidelines for DOAC therapy (CHADS2 ≥2) in Clalit Health Services from 2011 to 2016. Mean age of eligibility to DOAC therapy was 78 in both groups. Patients were followed to May 15, 2017, or death event. Drug adherence was assessed based on electronic records of DOAC prescription data. Patients were considered to be “on-therapy” up to 30 days of their last issued prescription.
Results: All-cause mortality rates were calculated for 19,881 patients treated with DOAC and 24,871 patients with no anticoagulation therapy. Compared to patients with no anticoagulation, risk adjusted hazard ratio for death for DOAC treated patients was 0.646 (95% CI: 0.621-0.672). While “on-therapy”, the risk of death of DOAC patients was halved to 0.329 (95% CI: 0.312-0.346).
Conclusions: In this cohort of general clinical practice NVAF patients, mortality rates were significantly lower with DOAC therapy. Our findings support further evidence for the importance of initiation and adherence of DOAC therapy in all eligible NVAF patients.