Anticoagulation in Subclinical AF May Offer Little Benefit
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.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
an hour ago
- Yahoo
‘It's violently anti-woman': Melissa Murray reflects on the criminalization of miscarriage
One in five women experience a miscarriage according to the National Institutes of Health, and now women who suffer pregnancy loss can face prosecution. One prosecutor in West Virginia even went so far as to suggest women call law enforcement after having a miscarriage to avoid prosecution. Amanda Zurawski, lead plaintiff in the Texas case that included 20 women who were denied emergency care, called this suggestion 'reprehensible' and 'terrifying.' NYU Professor Melissa Murray says that
Yahoo
an hour ago
- Yahoo
Major new study reveals jobs with the highest depression rate in the US
Job seekers may want to consider the toll that specific careers can have on their mental health. A huge new study published on Friday examined the relationship between careers and depression rates. The study analyzed survey data from 536,279 workers across 37 states from 2015 to 2019. Out of half a million U.S. workers, 80,319 of them admitted to being diagnosed with depression at some point during their lives, with women being diagnosed twice as often as men. Separating the results by industry, the study saw that people who worked in community and social services had the highest rate of lifelong diagnosed depression at 20.5 percent. The second highest on the list was food prep and serving jobs at 20.1 percent. Other industries with high lifetime diagnosed depression rates are: arts, entertainment, sports, and media at 18.6 percent; accommodation and food services at 18.4 percent; health and social assistance at 18.2 percent; retail trade at 17.7 percent; and legal, education, and library jobs tied at 16.1 percent. Industries with lower lifetime diagnosed depression rates included mining jobs at 6.7 percent, construction at 8.9 percent, and agriculture and engineering jobs at nine percent. Although mining and construction may have lower depression rates, those industries also have the highest suicide rates among U.S. workers. The researchers suggest that the gap may be explained because blue-collar men are less likely to seek mental services due to a preexisting stigma or limited access in rural areas. Despite the results of the study, there are some jobs out there that are almost stress-free and also come with a large paycheck. Back in December 2024, Resume Genius released its list of the highest-paying jobs that also reported low levels of stress. Their study described 'low-stress jobs' as ones that typically require fewer demands, more predictable work hours, supportive environments, and manageable workloads. All of the jobs on the list required the person to have at least a Bachelor's degree. The list was compiled using data from the U.S. Bureau of Labor Statistics (BLS) and the career site O*NET Online. The high-stress jobs were filtered out using O*NET and then cross-referenced against the BLS's Occupational Outlook Handbook, with the national median salary set at $48,060 and viewing jobs that showed 'faster-than-average growth.' The best jobs included: water source specialist, astronomer, actuary, environmental economist, mathematician, and geographer.
Yahoo
an hour ago
- Yahoo
How will the measles outbreak in Alberta affect kids?
With the measles count inching closer to the 1,000 mark in Alberta, this could mean dire consequences for the province's youngest and most vulnerable. As of Friday, the province has recorded 778 cases of the measles in Alberta, with 364 diagnosed within kids and teenagers aged five to 17 years. Over 200 cases have been diagnosed in children younger than five years old, a demographic Dr. Daniel Gregson, an infectious disease specialist says is especially vulnerable to developing serious complications from the virus. 'Measles complication rates are higher the younger you are and so, under five, you have a much higher incidence of complications which require hospitalizations,' he said. 'Common ones are pneumonia, unremitting diarrhea and then there are some rare complications like encephalitis that can result in admissions as well.' As of the time this article was published, five people are hospitalized, two of whom are in the ICU. For weeks, doctors, experts and government officials have encouraged Albertans to get vaccinated against the measles, attributing the rise in cases to poor vaccination rates over the last two decades. The reason the infection is spreading fastest among kids and teenagers is because of the low immunization rates in that demographic, according to Gregson. 'And transmission also happens when people who are not immunized gather together in large numbers and that's generally in schools.' With school almost out for the summer, that may mitigate the exponential rise in cases but with the count inching closer to 1,000, that increases the possibility of fatalities. But it's a difficult infection to control, Gregson cautioned, because it can be transmitted airborne and can stay in the air for approximately two hours after being released. 'So you can imagine, someone going to a store to pick up something,' he said. 'There could have been somebody in there who had been incubating in that four-day window and breathing in the store and then the store becomes a source of infection for other people, even when that person is no longer there.' Most adults who get the measles would see experience cold-like symptoms and a rash. But the complications arise for children who could also experience ear infections, pneumonia, dehydration and in rare cases encephalitis and blindness. On average, one patient in every 1,000 affected could die from the disease, although it's difficult to predict how that may pattern. 'We may see no deaths for the first thousand and then see three deaths in the second thousand,' he hypothesized. Should cases rise into the quadruples, kids younger than five years are most vulnerable to fatalities, he said. Ontario recorded its first death of the year from the measles outbreak in the province, after an infant born prematurely died from contracting the virus before birth. It is possible for pregnant mothers to pick up the infection and transmit to their babies pre-birth, Gregson said. 'It could be quite devastating.' A pregnant mother infected with the disease could see increased risk of a premature birth, a miscarriage, a stillborn birth or a low baby weight. The infection if passed on, could mean congenital measles for the fetus and respiratory complications post-birth.
