Table 1.
Univariate analyses of the association of demographic, stroke and bleeding risk factors, AF characteristics, clinical parameters, treatment strategies, and health-care setting with NOAC use; and independent predictors of NOAC use in patients given OAC therapy
| All (NOAC and VKA) n = 1960 (%) |
NOAC n = 338 (12.7) |
VKA n = 1622 (82.8) |
p | OR | 95% CI | p | |
|---|---|---|---|---|---|---|---|
| Univariate analyses | |||||||
| Demographics | |||||||
| Age (mean) | 68.95 ± 10.25 | 68.47 ± 11.50 | 69.05 ± 9.97 | 0.345 | 0.99 | 0.98–1.01 | 0.345 |
| Age <65 years (%) | 633 (32.3) | 117 (34.6) | 516 (31.8) | 0.338 | 1.14 | 0.89–1.45 | 0.316 |
| Age 65–74 years (%) | 663 (33.8) | 104 (30.8) | 559 (34.5) | 0.206 | 0.85 | 0.66–1.09 | 0.192 |
| Age ≥75 years (%) | 664 (33.9) | 117 (34.6) | 547 (33.7) | 0.752 | 1.04 | 0.81–1.33 | 0.753 |
| Age ≥80 years (%) | 269 (13.7) | 56 (16.6) | 213 (13.1) | 0.099 | 1.31 | 0.95–1.81 | 0.096 |
| Female gender (%) | 874 (44.6) | 144 (42.6) | 730 (45.0) | 0.435 | 0.91 | 0.72–1.15 | 0.419 |
| Current smoker (%) | 239 (12.2) | 48 (14.2) | 191 (11.8) | 0.235 | 1.24 | 0.88–1.74 | 0.216 |
| Ever smoker (%) | 587 (29.9) | 102 (30.2) | 485 (29.9) | 0.948 | 1.01 | 0.79–1.31 | 0.920 |
| Alcohol abuse (%) | 80 (4.1) | 17 (5.0) | 63 (3.9) | 0.363 | 1.31 | 0.76–2.27 | 0.334 |
| Body mass index | 28.03 ± 4.43 | 27.71 ± 4.07 | 28.10 ± 4.51 | 0.134 | 0.98 | 0.95–1.01 | 0.134 |
| Stroke and bleeding risk | |||||||
| CHA2DS2-VASc cont. | 3.49 ± 1.72 | 3.33 ± 1.74 | 3.53 ± 1.72 | 0.051 | 0.93 | 0.87–1.00 | 0.051 |
| CHA2DS2-VASc ≥2 (%) | 1703 (86.9) | 280 (82.2) | 1423 (87.7) | 0.021 | 0.68 | 0.49–0.93 | 0.016 |
| CHADS2 cont. | 2.17 ± 1.25 | 2.09 ± 1.27 | 2.19 ± 1.25 | 0.177 | 0.94 | 0.86–1.03 | 0.177 |
| CHADS2 ≥2 (%) | 1304 (66.5) | 206 (60.9) | 1098 (67.7) | 0.019 | 0.75 | 0.59–0.95 | 0.017 |
| HASBLED cont. | 2.02 ± 1.25 | 1.79 ± 1.16 | 2.07 ± 1.26 | <0.001 | 0.83 | 0.75–0.92 | <0.001 |
| HASBLED ≥3 (%) | 634 (32.2) | 93 (27.5) | 541 (33.4) | 0.041 | 0.76 | 0.59-0.98 | 0.037 |
| Characteristics of AF | |||||||
| Symptomatic AFa (%) | 1526 (77.9) | 263 (77.8) | 1263 (77.9) | 1.000 | 0.99 | 0.75–1.32 | 0.966 |
| Permanent AF (%) | 862 (44.0) | 109 (32.2) | 753 (46.4) | <0.001 | 0.55 | 0.43–0.70 | <0.001 |
| Paroxysmal AF (%) | 589 (30.1) | 115 (34.0) | 474 (29.2) | 0.090 | 1.25 | 0.97–1.60 | 0.080 |
| First diagnosed AFb (%) | 376 (19.2) | 85 (25.2) | 291 (18.0) | 0.003 | 1.54 | 1.17–2.03 | 0.002 |
| Clinical parameters | |||||||
| Heart failure ever (%) | 873 (44.6) | 119 (35.2) | 754 (46.5) | <0.001 | 0.57 | 0.44–0.73 | <0.001 |
| Heart failure at presentation (%) | 827 (42.7) | 106 (31.4) | 721 (44.5) | <0.001 | 0.63 | 0.49-0.80 | <0.001 |
| Hypertension (%) | 1603 (81.8) | 288 (85.2) | 1315 (81.1) | 0.075 | 1.35 | 0.97–1.86 | 0.074 |
| Coronary artery disease (any) (%) | 568 (29.0) | 86 (25.4) | 482 (29.7) | 0.129 | 0.81 | 0.62–1.05 | 0.114 |
| Stable CAD (%) | 406 (20.7) | 58 (17.2) | 348 (21.5) | 0.077 | 0.76 | 0.56–1.03 | 0.076 |
| PCI (%) | 162 (8.3) | 28 (8.3) | 134 (8.3) | 1.000 | 1.00 | 0.66–1.54 | 0.989 |
| Prior MI (%) | 247 (12.6) | 23 (6.8) | 224 (13.8) | <0.001 | 0.46 | 0.29–0.71 | 0.001 |
| Prior CABG (%) | 73 (3.7) | 6 (1.8) | 67 (4.1) | 0.039 | 0.42 | 0.18–0.98 | 0.044 |
| Vascular disease (any) (%) | 401 (20.5) | 57 (16.9) | 344 (21.2) | 0.075 | 0.75 | 0.55–1.03 | 0.072 |
| PAD (%) | 93 (4.7) | 16 (4.7) | 77 (4.8) | 1.000 | 1.00 | 0.58–1.74 | 0.999 |
| Dilated cardiomyopathy (%) | 183 (9.3) | 22 (6.5) | 161 (9.9) | 0.051 | 0.63 | 0.40–1.00 | 0.051 |
| Hypertrophic cardiomyopathy (%) | 40 (2.0) | 5 (1.5) | 35 (2.2) | 0.529 | 0.68 | 0.27–1.75 | 0.425 |
| Valve disease (%) | 715 (36.5) | 80 (23.7) | 635 (39.1) | <0.001 | 0.48 | 0.37–0.63 | <0.001 |
| Mitral valve disease (%) | 653 (33.3) | 75 (22.2) | 578 (35.6) | <0.001 | 0.52 | 0.39–0.68 | <0.001 |
| Aortic valve disease (%) | 212 (10.8) | 22 (6.5) | 190 (11.7) | 0.004 | 0.53 | 0.33–0.83 | 0.006 |
| Other cardiac disease (%) | 158 (8.1) | 14 (4.1) | 144 (8.9) | 0.003 | 0.44 | 0.25–0.78 | 0.005 |
| Diabetes mellitus (%) | 488 (24.9) | 78 (23.1) | 410 (25.3) | 0.408 | 0.89 | 0.67–1.17 | 0.395 |
| Chronic kidney disease (%) | 309 (15.8) | 56 (16.6) | 253 (15.6) | 0.682 | 1.07 | 0.78–1.47 | 0.660 |
| CKD on dialysis (%) | 5 (1.6) | 0 (0.0) | 5 (2.0) | 0.589 | 0.00 | 0.00–0.00 | 0.999 |
| COPD (%) | 234 (11.9) | 29 (8.6) | 205 (12.6) | 0.042 | 0.65 | 0.43–0.98 | 0.038 |
| Sleep apnea (%) | 42 (2.1) | 5 (1.5) | 37 (2.3) | 0.589 | 0.64 | 0.25–1.65 | 0.358 |
| Dementia (%) | 40 (2.0) | 3 (0.9) | 37 (2.3) | 0.136 | 0.38 | 0.12–1.25 | 0.112 |
| Thyroid disease (%) | 219 (11.2) | 48 (14.2) | 171 (10.5) | 0.058 | 1.40 | 0.99–1.98 | 0.053 |
| Liver disease (%) | 63 (3.2) | 14 (4.1) | 49 (3.0) | 0.308 | 1.39 | 0.76–2.54 | 0.290 |
| Malignancy (%) | 82 (4.2) | 22 (6.5) | 60 (3.7) | 0.025 | 1.81 | 1.10–3.00 | 0.021 |
| Anemia (%) | 244 (12.5) | 34 (10.1) | 210 (13.0) | 0.148 | 0.75 | 0.51–1.10 | 0.144 |
| Prior bleedinga (%) | 93 (4.7) | 21 (6.2) | 72 (4.4) | 0.160 | 1.43 | 0.87–2.36 | 0.161 |
| Prior stroke (%) | 209 (10.7) | 36 (10.7) | 173 (10.7) | 1.000 | 1.00 | 0.68–1.46 | 0.994 |
| Prior TIA (%) | 57 (2.9) | 13 (3.8) | 44 (2.7) | 0.284 | 1.43 | 0.76–2.69 | 0.263 |
| Prior pulmonary embolism (%) | 42 (2.1) | 3 (0.9) | 39 (2.4) | 0.097 | 0.36 | 0.11–1.18 | 0.093 |
| Prior systemic TE (%) | 17 (0.9) | 1 (0.3) | 16 (1.0) | 0.335 | 0.30 | 0.04–2.26 | 0.242 |
| Treatment strategies | |||||||
| Planned electrical cardioversion (%) | 92 (4.7) | 23 (6.8) | 69 (4.2) | 0.048 | 1.64 | 1.01–2.68 | 0.046 |
| Planned AF ablation (%) | 56 (3.5) | 12 (3.6) | 44 (2.7) | 0.373 | 1.32 | 0.69–2.53 | 0.402 |
| Rhythm control (%) | 639 (32.6) | 154 (45.6) | 485 (29.9) | <0.001 | 1.96 | 1.55–2.49 | <0.001 |
| Rate control (%) | 1261 (64.6) | 179 (53.4) | 1082 (66.9) | <0.001 | 0.57 | 0.45–0.72 | <0.001 |
| Prior OAC therapy (%) | 1335 (68.1) | 155 (45.8) | 1180 (72.7) | <0.001 | 0.39 | 0.29–0.52 | <0.001 |
| Dual therapy (%) | 240 (12.2) | 26 (7.7) | 214 (13.2) | 0.005 | 0.59 | 0.36–0.84 | 0.006 |
| Triple therapy (%) | 83 (4.2) | 11 (3.3) | 72 (4.4) | 0.375 | 0.33 | 0.38–1.38 | 0.328 |
| Health-care setting | |||||||
| Capital city center (%) | 986 (50.3) | 187 (55.3) | 799 (49.3) | 0.048 | 1.28 | 1.01–1.61 | 0.043 |
| Hospital-based center (%) | 1813 (92.3) | 273 (80.8) | 1540 (94.9) | <0.001 | 0.22 | 0.16–0.32 | <0.001 |
| Outpatient center (%) | 147 (7.5) | 65 (19.2) | 82 (5.1) | <0.001 | 4.47 | 3.15–6.35 | <0.001 |
| University center (%) | 1613 (89.0) | 244 (89.4) | 1369 (88.9) | 0.917 | 1.05 | 0.69–1.59 | 0.815 |
| Treatment by a cardiologist (%) | 1594 (81.3) | 310 (91.7) | 1284 (79.2) | <0.001 | 2.91 | 1.94–4.37 | <0.001 |
| Multivariable analysis | |||||||
| Heart failure at current visit | 0.65 | 0.48–0.87 | 0.004 | ||||
| Valve disease | 0.66 | 0.49–0.88 | 0.006 | ||||
| Malignancy | 2.06 | 1.20–3.56 | 0.009 | ||||
| Rhythm control strategy | 1.64 | 1.25–2.16 | <0.001 | ||||
| Dual therapy | 0.54 | 0.34–0.86 | 0.009 | ||||
| Prior OAC therapy | 0.59 | 0.48–0.71 | <0.001 | ||||
| Treatment by a cardiologist | 2.32 | 1.51–3.54 | <0.001 | ||||
| Hospital-based center | 0.25 | 0.17–0.37 | <0.001 | ||||
NOAC non-vitamin K antagonist oral anticoagulant, VKA vitamin K antagonist, AF atrial fibrillation, CAD coronary artery disease, PCI percutaneous coronary intervention, MI myocardial infarction, CABG coronary artery bypass grafting, PAD peripheral arterial disease, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, TIA transient ischemic attack, TE thromboembolic event, OAC oral anticoagulan
aData missing for one patient
bUnknown for 3 patients