Association of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry

Abstract Background Persistence to oral anticoagulation (OAC) is crucial to prevent recurrent stroke in patients with atrial fibrillation (AF). Little is known about the association of OAC intake, persistence to OAC, and type of OAC with health-related quality of life (HRQoL) in stroke survivors with AF. Methods This retrospective analysis of the multicenter Berlin Atrial Fibrillation Registry included 1,042 patients with acute ischemic stroke or transient ischemic attack (TIA) and AF. HRQoL data were measured at 3,12,24 and 36 months after stroke/TIA using the EQ-5D-3 L questionnaire (including EQ-Index and EQ-VAS). Associations between OAC status, persistence to and type of OAC (direct oral anticoagulants (DOACs) against vitamin K antagonists (VKAs)) at 12 and up to 36 months with HRQoL were examined using multivariable linear models. Results Overall, 842 patients completed the 12-months follow-up and 437 patients the 36-months follow-up. After 12 months, OAC intake was associated with higher EQ-VAS scores (β = 6.70, p = 0.017), although this effect was not observed up to 36 months (ß= -3.67, p = 0.075). Non-persistence to OAC was associated with lower EQ-VAS scores at 12 (ß= -6.25, p = 0.004) and 36 months (ß= -5.39, p < 0.001). No evidenve of a statistically significant difference in HRQoL was found between patients persistent to DOACs and those persistent to VKAs. EQ-Index values were not statistically significantly affected. Conclusion Non-persistence to OAC was associated with reduced EQ-VAS up to 36 months after stroke. Notably, no evidence of a statistically significant difference regarding HRQOL was found between patients persistent on DOAC or VKA. Ensuring long-term persistence to OAC may support HRQoL in stroke survivors with AF.