Outcomes in patients with atrial fibrillation with and without heart failure on oral anticoagulants: a multicenter retrospective cohort study

BACKGROUND: Multicenter real-world data on anticoagulated patients with atrial fibrillation (AF) and heart failure (HF) remain limited, particularly in Chinese populations. This study compared clinical outcomes in AF patients receiving oral anticoagulants (OACs) according to HF status. METHODS: We conducted a multicenter retrospective cohort study across four hospitals in China and included 4,878 AF patients who received OACs after discharge between January 2019 and August 2023. Patients were classified into HF (n = 2,371) and non-HF (n = 2,507) groups and followed for a median of 19 months. a. Logistic regression analysis was used to assess the associations between HF and clinical outcomes. Propensity score matching (PSM) was to matched HF and no-HF cohorts and to compare rivaroxaban with warfarin among patients with HF. RESULTS: After multivariable adjustment, HF was independently associated with higher risk of all-cause death(adjusted OR 1.414, 95% CI 1.118-1.787; P = 0.004), and not significantly different in risks of total bleeding, major bleeding, gastrointestinal bleeding, intracranial hemorrhage, minor bleeding, thrombosis, or ischemic stroke compare with non-HF. After 1:1 PSM, HF remained associated with higher risk of all-cause death. In the matched HF subgroup, rivaroxaban was associated with lower risk of all-cause death than warfarin (OR 0.619, 95% CI 0.422-0.907; P = 0.014). CONCLUSION: Among AF patients receiving OACs, concomitant HF was associated with increased risk of all-cause death. In the matched HF subgroup, rivaroxaban was associated with lower risk of all-cause death than warfarin. These findings should be interpreted cautiously given the retrospective observational design and the lack of INR and time-in-therapeutic-range data for warfarin-treated patients.