Background: Atrial fibrillation (AF) is one of the major comorbidities in patients with heart failure (HF). Antithrombotic agents, especially anticoagulants (ACs), are widely used for AF patients to prevent thromboembolic events including stroke. However, it remains to be fully elucidated whether ACs, anti-platelets (APs), and their combination have beneficial prognostic impacts in AF patients, particularly in those with HF.
Methods and Results: Using the database of our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (N=10,219), 3,221 consecutive AF patients were examined. They were divided into 4 groups based on antithrombotic therapies (ATT) at enrollment; without ATT (w/o ATT, N=368, mean age 71 yrs.), ACs alone (ACs, N=1,073, mean age 70 yrs.), APs alone (APs, N= 838, mean age 73 yrs.), and both of them (ACs/APs, N=942, mean age 70 yrs.). As compared with w/o ATT group, all other 3 groups had significantly improved all-cause mortality (adjusted hazard ratio (aHR) 0.68, 0.76, and 0.69 for ACs, APs, and ACs/APs, respectively, all P<0.05) and cardiovascular mortality (aHR 0.65, 0.66, and 0.59, respectively, all P<0.05). Importantly, as compared with w/o ATT groups, all other 3 groups had significantly reduced cardiovascular mortality in patients with HF (Stage C/D), but not in those without HF (Stage A/B) (Figure). The use of ACs was significantly associated with reduced all-cause mortality in HF patients (aHR 0.66 and 0.69 for ACs and ACs/APs, respectively, both P<0.05), but not in those without HF (aHR 0.70 and 0.73, respectively, both n.s.). The beneficial effects of ATT (ACs, APs, and ACs/APs) were noted in patients with non-paroxysmal AF (PAF) (aHR 0.56, 0.48, and 0.43, respectively, all P<0.05), but not in those with PAF (aHR 0.62, 0.96, and 0.85, respectively).
Conclusions: These results indicate that ATT is associated with improved mortality in AF patients, particularly in those with HF and those with non-PAF.