Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants

Background: Malnutrition has been reported to be associated with worse clinical outcomes in various cardiovascular diseases. We aimed to investigate the clinical significance of the nutritional status in atrial fibrillation (AF) patients aged 80 years and over receiving oral anticoagulants (OACs), focusing on the difference between direct OACs (DOACs) and warfarin treatment. Methods: This was a retrospective and observational study. We enrolled 332 consecutive AF patients aged 80 years and over who were treated with OACs: DOACs (n = 256) and warfarin (n = 76). A controlling nutritional status (CONUT) score was used to evaluate the nutritional status. The enrolled patients were divided into two groups based on the CONUT score: CONUT score <5 (n = 239) and CONUT score >= 5 (n = 93) groups. We investigated the relationship between the nutritional status and clinical outcomes. Results: The CONUT score >= 5 group had significantly higher incidence of major bleeding (MB) compared to the CONUT score <5 group (4.6/100 person-years vs. 0.7/100 person-years, p < 0.01). On Cox hazard analysis, CONUT score >= 5 group was significantly associated with increased MB compared with the CONUT score <5 group (hazard ratio: 5.80, 95% confidence interval: 1.44-23.33, p = 0.013). In the DOAC group, the incidence of MB did not differ between the CONUT score >= 5 and CONUT score <5 groups (p = 0.54). In the warfarin group, MB occurred more frequently in the CONUT score >= 5 group than CONUT score <5 group (p < 0.01). There was no significant difference in the incidence of thromboembolic events between the CONUT score >= 5 and CONUT score <5 groups in both the DOAC and warfarin groups. Conclusions: The prognostic values of the nutritional status based on the CONUT score for MB differed between AF patients aged 80 years and over receiving DOACs and those receiving warfarin. It may be favorable to use DOACs to avoid bleeding events in those with malnutrition. (C) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.