PLoS ONE (Jan 2023)

Clinical phenotypes of older adults with non-valvular atrial fibrillation not treated with oral anticoagulants by hierarchical cluster analysis in the ANAFIE Registry.

  • Shinya Suzuki,
  • Takeshi Yamashita,
  • Masaharu Akao,
  • Hirotsugu Atarashi,
  • Takanori Ikeda,
  • Ken Okumura,
  • Yukihiro Koretsune,
  • Wataru Shimizu,
  • Hiroyuki Tsutsui,
  • Kazunori Toyoda,
  • Atsushi Hirayama,
  • Masahiro Yasaka,
  • Takenori Yamaguchi,
  • Satoshi Teramukai,
  • Tetsuya Kimura,
  • Yoshinori Morishima,
  • Atsushi Takita,
  • Hiroshi Inoue

DOI
https://doi.org/10.1371/journal.pone.0280753
Journal volume & issue
Vol. 18, no. 2
p. e0280753

Abstract

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BackgroundAlthough anticoagulants are indicated for many elderly patients with non-valvular atrial fibrillation (NVAF), some patients do not receive anticoagulant therapy, whose characteristics and outcomes are diverse.Methods and resultsIn this sub-analysis of the All Nippon AF In the Elderly (ANAFIE) Registry, the phenotypes of patients who were not receiving anticoagulants at baseline were evaluated by cluster analysis using Ward's linkage hierarchical algorithm. Of 32,275 enrolled patients, 2445 (7.6%) were not receiving anticoagulants. Two clusters were identified: (1) elderly paroxysmal AF (PAF) patients with a high proportion of catheter ablation history (57%) and (2) very elderly patients with a high prevalence of previous major bleeding (43%). Respective mean ages were 80.9 and 84.2 years, mean CHA2DS2-VASc scores were 3.8 and 4.9, PAF prevalences were 100.0% and 31.4%, proportions of patients with catheter ablation history were 21.0% and 7.9%, and proportions of patients with a history of major bleeding were 4.0% and 10.8%. Annual incidence rates were 2.72% and 8.81% for all-cause death, 1.66% and 5.85% for major adverse cardiovascular or neurological events, 1.08% and 3.30% for stroke or systemic embolism, and 0.69% and 1.19% for major bleeding, respectively.ConclusionsIn this cohort of elderly NVAF patients from the ANAFIE Registry who were not receiving anticoagulants, over half had PAF with a high proportion of catheter ablation history and a low incidence of adverse outcomes; for them, non-prescription of anticoagulants may be partially understandable, but they should be carefully monitored regarding AF burden or atrial cardiomyopathy and be adequately anticoagulated when adverse findings are detected. The remaining were very elderly patients with a high prevalence of previous major bleeding and a high incidence of adverse outcomes; for them, non-prescription of anticoagulants is inappropriate because of the high thromboembolic risk.Trial registrationRegistration: http://www.umin.ac.jp/; Unique identifier: UMIN000024006.