ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Compliance to direct oral anticoagulation therapy and clinical outcomes after catheter ablation for atrial fibrillation: a nationwide cohort study.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsLife-long direct oral anticoagulant (DOAC) therapy is recommended after catheter ablation for atrial fibrillation (AF) in high-risk patients (CHA2DS2-VA≥2). Long-term DOAC compliance is crucial for effective stroke prevention. This study seeks to evaluate long-term compliance measured by adherence and persistence to DOAC therapy following first-time catheter abltation for AF. METHODS AND
resultsAll Danish patients undergoing first-time catheter ablation between 2017 and 2024 were identified through Danish registries. Patients were stratified by CHA2DS2-VA score 0, 1, and ≥2. Primary outcomes were adherence and persistence to DOAC therapy at 1, 2, and 3 years after first-time catheter ablation. Adherence was defined as the proportion of days covered (PDC) ≥80%. Persistence was assessed as the proportion of patients covered based on the most recent pharmacy redemption before specific time points, given a 20% grace period. A total of 13 438 patients (32.1% female) were included. At 3 years post-ablation, the proportion of adherent patients with CHA2DS2-VA ≥2 (n = 7322) was 87.6% [95% cinfidence interval (CI): 86.8-88.4]. Applying a sensitivity analysis with a PDC ≥90% threshold, the proportion was 78.8% (95% CI: 77.8-79.8%). Persistence was 73.0% (95% CI: 71.6-74.4%) at 3 years. Rates of thromboembolic outcomes were low with a total incidence rate of the combined outcome of ischaemic stroke, transient ischaemic attack and systemic embolism at 6.6 per 1000 person-years (95% CI: 5.8-7.4). The incidence of major bleeding was found at 7.1 per 1000 person-years (95% CI: 6.3-8.0) for the combined cohort.
conclusionWhile adherence to DOAC therapy was acceptable in patients with CHA2DS2-VA≥2, persistence declined over time and more than 20% were non-persistent by 3 years. Efforts to improve effective long-term stroke prevention may be warranted. UNSTRUCTURED ABSTRACT: Life-long direct oral anticoagulant (DOAC) therapy is recommended after catheter ablation for atrial fibrillation in high-risk patients (CHA2DS2-VA≥2). Adherence and persistence to DOAC is crucial for effective stroke prevention.Danish patients undergoing first-time catheter ablation between 2017 and 2024 were identified through registries.A total of 13 438 patients were included. At 3 years post-ablation, the proportion of adherent and persistent patients with CHA2DS2-VA ≥2 (n = 7322) was 87.6% and 73.0%, respectively.Adherence to DOAC was acceptable in patients with CHA2DS2-VA≥2. More than 20% of patients were non-persistent by 3 years. Efforts to improve effective long-term stroke prevention may be warranted.
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