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Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―

Background: Few studies in Japan have reported on follow-up data regarding the clinical course and risk factors for adverse outcomes in elderly patients with non-valvular atrial fibrillation (NVAF), vs. younger patients, when considering the competing risk of death. Methods and Results: We prospecti...

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Autores principales: Tsuda, Toyonobu, Hayashi, Kenshi, Kato, Takeshi, Usuda, Keisuke, Kusayama, Takashi, Nomura, Akihiro, Tada, Hayato, Usui, Soichiro, Sakata, Kenji, Kawashiri, Masa-aki, Fujino, Noboru, Yamagishi, Masakazu, Takamura, Masayuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Circulation Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257453/
https://www.ncbi.nlm.nih.gov/pubmed/35860347
http://dx.doi.org/10.1253/circrep.CR-22-0012
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author Tsuda, Toyonobu
Hayashi, Kenshi
Kato, Takeshi
Usuda, Keisuke
Kusayama, Takashi
Nomura, Akihiro
Tada, Hayato
Usui, Soichiro
Sakata, Kenji
Kawashiri, Masa-aki
Fujino, Noboru
Yamagishi, Masakazu
Takamura, Masayuki
author_facet Tsuda, Toyonobu
Hayashi, Kenshi
Kato, Takeshi
Usuda, Keisuke
Kusayama, Takashi
Nomura, Akihiro
Tada, Hayato
Usui, Soichiro
Sakata, Kenji
Kawashiri, Masa-aki
Fujino, Noboru
Yamagishi, Masakazu
Takamura, Masayuki
author_sort Tsuda, Toyonobu
collection PubMed
description Background: Few studies in Japan have reported on follow-up data regarding the clinical course and risk factors for adverse outcomes in elderly patients with non-valvular atrial fibrillation (NVAF), vs. younger patients, when considering the competing risk of death. Methods and Results: We prospectively studied 1,328 patients with NVAF (965 men; mean [±SD] age 72.4±9.7 years) from the Hokuriku-Plus AF Registry with a median follow-up of 5.0 years (interquartile range 3.5–5.3 years) and evaluated the incidence of thromboembolism or major bleeding in elderly (age ≥75 years; n=595) and non-elderly (age <75 years; n=733) patients. Analysis using the Gray method showed no significant difference in the incidence of thromboembolism; however, the incidence of major bleeding was significantly higher in the elderly than non-elderly group. The Fine-Gray model, after adjustment for age and sex in the elderly group, showed that age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.02–1.13; P=0.004) and warfarin use (HR 1.87; 95% CI 1.12–3.14; P=0.02) were significantly associated with major bleeding. In the elderly group, those using warfarin had a higher incidence of thromboembolism and major bleeding than those using direct oral anticoagulants (DOACs). Conclusions: The efficacy and safety of DOACs were remarkable in elderly compared with non-elderly patients with NVAF considering the competing risk of death. DOACs may be a favorable choice in elderly patients with NVAF.
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spelling pubmed-92574532022-07-19 Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ― Tsuda, Toyonobu Hayashi, Kenshi Kato, Takeshi Usuda, Keisuke Kusayama, Takashi Nomura, Akihiro Tada, Hayato Usui, Soichiro Sakata, Kenji Kawashiri, Masa-aki Fujino, Noboru Yamagishi, Masakazu Takamura, Masayuki Circ Rep Original article Background: Few studies in Japan have reported on follow-up data regarding the clinical course and risk factors for adverse outcomes in elderly patients with non-valvular atrial fibrillation (NVAF), vs. younger patients, when considering the competing risk of death. Methods and Results: We prospectively studied 1,328 patients with NVAF (965 men; mean [±SD] age 72.4±9.7 years) from the Hokuriku-Plus AF Registry with a median follow-up of 5.0 years (interquartile range 3.5–5.3 years) and evaluated the incidence of thromboembolism or major bleeding in elderly (age ≥75 years; n=595) and non-elderly (age <75 years; n=733) patients. Analysis using the Gray method showed no significant difference in the incidence of thromboembolism; however, the incidence of major bleeding was significantly higher in the elderly than non-elderly group. The Fine-Gray model, after adjustment for age and sex in the elderly group, showed that age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.02–1.13; P=0.004) and warfarin use (HR 1.87; 95% CI 1.12–3.14; P=0.02) were significantly associated with major bleeding. In the elderly group, those using warfarin had a higher incidence of thromboembolism and major bleeding than those using direct oral anticoagulants (DOACs). Conclusions: The efficacy and safety of DOACs were remarkable in elderly compared with non-elderly patients with NVAF considering the competing risk of death. DOACs may be a favorable choice in elderly patients with NVAF. The Japanese Circulation Society 2022-06-15 /pmc/articles/PMC9257453/ /pubmed/35860347 http://dx.doi.org/10.1253/circrep.CR-22-0012 Text en Copyright © 2022, THE JAPANESE CIRCULATION SOCIETY https://creativecommons.org/licenses/by-nc-nd/4.0/This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
spellingShingle Original article
Tsuda, Toyonobu
Hayashi, Kenshi
Kato, Takeshi
Usuda, Keisuke
Kusayama, Takashi
Nomura, Akihiro
Tada, Hayato
Usui, Soichiro
Sakata, Kenji
Kawashiri, Masa-aki
Fujino, Noboru
Yamagishi, Masakazu
Takamura, Masayuki
Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title_full Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title_fullStr Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title_full_unstemmed Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title_short Clinical Characteristics, Outcomes, and Risk Factors for Adverse Events in Elderly and Non-Elderly Japanese Patients With Non-Valvular Atrial Fibrillation ― Competing Risk Analysis From the Hokuriku-Plus AF Registry ―
title_sort clinical characteristics, outcomes, and risk factors for adverse events in elderly and non-elderly japanese patients with non-valvular atrial fibrillation ― competing risk analysis from the hokuriku-plus af registry ―
topic Original article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257453/
https://www.ncbi.nlm.nih.gov/pubmed/35860347
http://dx.doi.org/10.1253/circrep.CR-22-0012
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