, 2025-05-07 12:17:00
TOPLINE:
In a modeling analysis, initiating direct acting or nonvitamin K oral anticoagulants (DOAC/NOAC) in patients with device-detected subclinical atrial fibrillation (AF) provided a net gain of approximately 1 additional quality-adjusted week of life per patient over 10 years, equating to a 65.8% chance of treatment offering more benefits than withholding it.
METHODOLOGY:
- Previous randomized trials on the benefits of oral anticoagulants for managing subclinical AF remain inconclusive.
- Researchers conducted analytical modelling on October 1, 2024, to compare the net benefit of initiating or withholding treatment with DOACs in patients with device-detected subclinical AF who had similar risks for stroke and bleeding as patients in previous trials of anticoagulation in subclinical AF.
- The decision model was run over a 10-year simulation period for two cohorts of 10,000 patients each (mean age, 77 years), with only one of the cohorts receiving DOACs.
- Anticoagulation was modeled to reduce the risk for ischemic stroke by 32% and increase the risk for major bleeding by 62%.
- The main outcome was cumulative quality-adjusted life years (QALYs), with the model considering the numbers and severity of ischemic and hemorrhagic strokes, other intracranial and extracranial bleeding, and deaths.
TAKEAWAY:
- For patients with device-detected subclinical AF, initiating DOACs led to 21.7% fewer ischemic strokes and 1.1% fewer deaths but 37.3% more major bleeding events per 10,000 patients compared with no anticoagulation.
- These differences translated to 0.024 additional QALYs per patient in those receiving DOACs, equivalent to approximately 1 additional quality-adjusted week of life during the 10-year simulation period.
- Further analysis revealed a 65.8% probability of treatment with DOACs yielding more QALYs than withholding treatment.
IN PRACTICE:
“[The study] results suggest that the question of whether or not to start NOACs for a patient with subclinical AF may actually have very limited clinical significance. It is also worth noting that the probabilistic sensitivity analysis indicated a 34% possibility that the treatment could be harmful to the patient,” the authors of the study wrote.
SOURCE:
This study was led by Aleksi K. Winstén, MSc, of the University of Turku in Turku, Finland. It was published online on May 2, 2025, in JAMA Network Open.
LIMITATIONS:
This study faced inherent challenges associated with mathematical modeling of complex real-life scenarios. Nonmajor bleeding events were not included in the analysis. The model operated under the assumption of complete adherence to the initiated DOACs.
DISCLOSURES:
This study received support from the Turku University Foundation, the Finnish Foundation for Cardiovascular Research, and the Finnish State Research Funding from the Heart Center of Turku University Hospital. One author reported receiving grants from multiple sources including the funding agencies. Three other authors reported receiving grants and/or personal fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
