One‐year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF‐NET) Registry

Abstract

Background Although anticoagulation therapy could reduce the risk of strokes in patients with atrial fibrillation (AF), large‐scale investigations in the direct oral anticoagulant (DOAC) and AF catheter ablation (CA) era are lacking. Methods This study was designed as a prospective, multicenter, observational study and a total of 2113 patients from 22 institutions were enrolled in the Hyogo area. Results The mean age and CHADS2 score were 70.1 ± 10.8 years old and 1.5 ± 1.1, respectively. The follow‐up period was 355 ± 43 days. CA was performed in 614 (29%) and DOACs were prescribed in 1118 (53%) patients. Ischemic strokes/systemic embolisms (SEs) and major bleeding occurred in 13 (0.6%) and 17 (0.8%) patients, respectively. New onset dementia, hospitalizations for cardiac events, and all‐cause death occurred in eight (0.4%), 60 (2.8%), and 29 (1.4%) patients, respectively. A multivariate analysis demonstrated that persistent AF and the body weight (BW) were associated with ischemic strokes/SEs and major bleeding, respectively (persistent AF: hazard ratio, 9.57; 95%CI, 1.2‐74.0; P = .03; BW: hazard ratio, 0.94; 95%CI, 0.90‐0.99; P = .02). AFCA history was associated with the cardiac events (hazard ratio, 0.44; 95%CI, 0.20‐0.99; P = .04). Age was associated with new onset dementia (hazard ratio, 1.1; 95%CI, 1.0‐1.2; P = .03). Conclusions In the DOAC and CA era, the incidence of ischemic strokes/SEs, major bleeding and cardiac events could be dramatically reduced in patients with AF. However, some unsolved issues of AF management still remain especially in elderly patients with persistent AF and a low BW.

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

“…A pooled meta-analysis of these studies demonstrated a hazard ratio of 0.60 (95% confidence interval 0.42–0.88, p < 0.05 with an I 2 value of 50%). Hyogo et al found that new onset dementia occurred in 8 of 2113 (0.4%) atrial fibrillation patients [ 18 ]. In the 614 patients who had been treated with catheter ablation, 3 (0.5%) had developed dementia over the 1 year follow up period.…”

Avaliação do impacto dos anticoagulantes na incidência de demência em pacientes com fibrilação atrial: uma revisão narrativa

“…Hyogo et al 24 acompanharam 2113 participantes com FA por 1 ano, com o objetivo de avaliar os desfechos primários (infarto cerebral sintomático, incluindo ataque isquêmico transitório, embolismos sistêmicos e complicações hemorrágicas fatais necessitando de hospitalização) e secundários (novos sinais de demência, eventos cardíacos que causam hospitalizações e outras causas de morte, sendo que o diagnóstico de demência foi dado pelo miniexame do estado mental e/ou Hasegawa) em pacientes que faziam uso de NOACs e varfarina. Como resultado, concluiu-se que, os desfechos primários foram encontrados em nove (1,3%) dos usuários de NOAC e em 15 (2,2%) dos usuários de varfarina.…”

“…Já os desfechos secundários, foram encontrados em 24 (3,6%) dos usuários de NOAC e em 36 (5,4%) dos usuários de varfarina. A incidência de novo início de demência, não diferiu entre os usuários de NOAC e varfarina (1 [0,1%] vs. 3 [0,4%] de 667 pacientes, P = 0,32) 24 .…”

The new era of atrial fibrillation treated by direct oral anticoagulants and catheter ablation—Comment on the “HAF‐NET Registry”

“…Anticoagulant drugs were used in 86% and DOACs in half of the patients with anticoagulants. 1 After the release of the DOACs, two clinical multicenter registry studies on AF were studied in Japan. 2,3 In the Fushimi AF Registry, where the patients were en- The SAKURA AF Registry also showed no significant difference in the rate of the strokes/systemic embolisms and the major bleeding rate between the DOACs and warfarin users (1.2% vs 1.8%/year and 0.5% vs 1.2%/year, respectively).…”

“…Almost 30% of the enrolled patients had a history of catheter ablation. Anticoagulant drugs were used in 86% and DOACs in half of the patients with anticoagulants . After the release of the DOACs, two clinical multicenter registry studies on AF were studied in Japan .…”