How does direct oral anticoagulant dosage affect long-term prognosis in patients with atrial fibrillation and heart failure? Results from the HEart failure ObsErvational Study (HEROES).

BACKGROUND

Most patients with heart failure (HF) and atrial fibrillation (AF) require direct oral anticoagulants (DOACs) at appropriate doses.

AIMS: We analyzed the prevalence of non-recommended DOAC prescriptions and their influence on long-term prognosis.

MATERIAL AND

METHODS

Patients with HF were included in the Heart failure ObsErvational Study, an observational, multicenter study. HF patients with AF treated with DOACs were included in the analysis.

RESULTS

Among the 459 patients, 46.8% were treated with apixaban, 34.9% were treated with rivaroxaban, and 18.3% with dabigatran. 71.7% of patients were treated with recommended doses of DOACs, 18.3% with doses lower than recommended and 10% with doses higher than recommended. The strongest factors associated with higher than recommended doses of prescribed DOACs were age ≥70.2 years (odds ratio [OR], 8.32; confidence interval [CI], 1.44-83.14; P = 0.03) and glomerular filtration rate <50 ml/min (OR, 34.16; CI, 6.18-324.93; P <0.001). The strongest factors associated with lower than recommended doses of DOACs were hemoglobin <12 g/dl (OR, 2.18; CI, 1.04-4.63; P = 0.039) and HF New York Heart Association class III/IV (OR, 2.82; CI, 1.2-7.23; P = 0.02). The risk of all-cause death was not significantly associated with receiving either higher or lower than recommended DOAC doses.

CONCLUSIONS

In the present study, a significant percentage of patients with AF and HF received non-recommended doses of DOACs. Factors that predisposed to the prescription of non-recommended DOAC doses included those that increased the risk of bleeding and thromboembolic complications. All-cause death in patients with HF and AF was not influenced by non-recommended DOAC doses.