Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Author:

Teppo Konsta1ORCID,Airaksinen K. E. Juhani1ORCID,Biancari Fausto2ORCID,Jaakkola Jussi1ORCID,Halminen Olli3ORCID,Linna Miika34ORCID,Haukka Jari5ORCID,Putaala Jukka6ORCID,Mustonen Pirjo1,Kinnunen Janne6ORCID,Luojus Alex5ORCID,Hartikainen Juha47ORCID,Aro Aapo L.8ORCID,Lehto Mika58ORCID

Affiliation:

1. Heart Center Turku University Hospital and University of Turku Turku Finland

2. Department of Medicine, South‐Karelia Central Hospital University of Helsinki Lappeenranta Finland

3. Department of Industrial Engineering and Management Aalto University Espoo Finland

4. Heart Center Kuopio University Hospital Kuopio Finland

5. University of Helsinki Helsinki Finland

6. Neurology Helsinki University Hospital, and University of Helsinki Helsinki Finland

7. University of Eastern Finland Kuopio Finland

8. Heart and Lung Center Helsinki University Hospital, University of Helsinki Helsinki Finland

Abstract

Background Patients with aortic stenosis (AS) have been underrepresented in the trials evaluating direct oral anticoagulants (DOACs) in atrial fibrillation (AF). We aimed to assess whether AS impacts outcomes in patients with AF and estimate the effects of DOACs versus warfarin in patients with AF and AS. Methods and Results The registry‐based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covered all patients with AF diagnosed during 2007 to 2018 in Finland. Hazard ratios (HRs) of first‐ever gastrointestinal bleeding, intracranial bleeding, any bleeding, ischemic stroke, and death were estimated with cause‐specific hazards regression adjusted for anticoagulant exposure variables. We identified 183 946 patients (50.5% women; mean age, 71.7 [SD, 13.5] years) with incident AF without prior bleeding or ischemic stroke, of whom 5231 (2.8%) had AS. The crude incidence rate of all outcomes was higher in patients with AS than in patients without AS. After propensity score matching, AS was associated with the hazard of any bleeding, gastrointestinal bleeding, and death but not with intracranial bleeding or ischemic stroke (adjusted HRs, 1.36 [95% CI, 1.25–1.48], 1.63 [95% CI, 1.43–1.86], 1.32 [95% CI, 1.26–1.38], 0.96 [95% CI, 0.78–1.17], and 1.11 [95% CI, 0.99–1.25], respectively). Among patients with AS, DOACs were associated with a lower risk of ischemic stroke when compared with warfarin, while bleeding and mortality did not differ between DOACs and warfarin. Conclusions AS is associated with substantially higher risk of gastrointestinal bleeding in patients with AF. DOACs may be more effective in preventing ischemic stroke than warfarin in patients with AF and AS. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04645537.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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