{"id":138160,"date":"2023-11-13T12:50:20","date_gmt":"2023-11-13T17:50:20","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138160"},"modified":"2023-11-13T12:50:20","modified_gmt":"2023-11-13T17:50:20","slug":"noah-afnet-6-ahre24-hours-associated-with-low-stroke-risk-but-more-likely-to-develop-af-later","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138160","title":{"rendered":"NOAH-AFNET 6: AHRE>24 hours associated with low stroke risk but more likely to develop AF later"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">This pre-specific subanalysis of NOAH-AFNET 6 found that those with long lasting atrial high rate episodes &gt;24 hours were more likely to develop atrial fibrillation (AF); there was no significant interaction found between the duration of the longest AHRE and the efficacy and safety of oral anticoagulation.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">The double-blinded, double dummy NOAH-AFNET 6 trial randomized elderly patients with device-detected AHREs and a median CHA2DS2VASC of 4\u2014but without an ECG diagnosis of AF\u2014to edoxaban or placebo.\u00a0 It was stopped early for a trend towards increased bleeding in the anticoagulation arm without a difference in stroke rates.<\/span><span style=\"font-weight: 400;\">1<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On November 12, 2023, Dr. Nina Becher presented the results of a pre-specific sub-analysis of NOAH-AFNET 6 entitled \u201cAnticoagulation with Edoxaban in Patients with Long Atrial High-Rate Episodes &gt;= 24 Hours\u201d at a Late Breaking Science Session of the American Heart Association Scientific Sessions in Philadelphia, PA, with simultaneous publication in <\/span><i><span style=\"font-weight: 400;\">European Heart Journal.<\/span><\/i><span style=\"font-weight: 400;\">2<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The purpose of this prespecified sub-analysis of NOAH-AFNET 6 was to assess the efficacy and safety of edoxaban compared to no anticoagulation among those with AHRE lasting &gt;=24 hours versus those with shorter episodes.\u00a0 While observational data suggests a higher stroke risk associated with longer AHREs, randomized data to support anticoagulation in patients with longer AHRE are lacking.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Overall, 2130 patients had AHRE &lt;24 hours, with 1062 receiving edoxaban and 1068 receiving placebo, while 259 had AHRE &gt; 24 hours, with 132 receiving edoxaban and 127 receiving placebo.\u00a0 The overall mean age was 78 years with a median CHADS2AVSC score of 4 and median HAS-BLED Score of 3.\u00a0 Those who were in the AHRE&gt;= 24 hour group also had a more total AHRE events.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There was no significant difference change in the primary composite efficacy outcome of ischemic stroke, systemic embolism, or cardiovascular death between the placebo and edoxaban groups based on AHRE duration of &gt;= 24 hours (p-value for interaction of 0.65).\u00a0 There was also no significant change noted in each of the individual components.\u00a0 These results were consistent when AHRE was used as a continuous variable or using median AHRE duration.\u00a0 There was also no significant difference noted in the composite safety outcome of major bleeding or death.\u00a0 Those with AHRE duration &gt;= 24 hours had a significantly higher incidence of ECG-diagnosed AF (assessed every 6 months per study protocol; HR 2.20; 95% CI 1.71,2.84, p&lt;0.001).\u00a0 The authors noted that this population was primarily White and the number of ischemic events was too small to rule out effects of anticoagulation on stroke prevention.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to Dr. Nina Becher of University Hospital Hamburg-Eppendorf: \u201cIn this prespecified sub-analysis of the NOAH-AFNET 6 trial, the rate of stroke appeared low in patients with AHRE durations \u226524 hours<\/span> <span style=\"font-weight: 400;\">and there was no interaction between the duration of the longest AHRE episode and the efficacy and safety of anticoagulation\u2026Further research is needed to identify patients with AHRE at higher risk of stroke and other cardiovascular events.\u201d<\/span><\/p>\n<p><b>References<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> Kirchhof P, Blank BF, Calvert M, et al. Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non\u2013vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH\u2013AFNET 6) trial. <\/span><i><span style=\"font-weight: 400;\">Am Heart J<\/span><\/i><span style=\"font-weight: 400;\">. 2017;190:12\u201318.<\/span><\/li>\n<li>Becher et al. Anticoagulation with edoxaban in patients with long Atrial High-Rate Episodes \u226524 hours. <i><span style=\"font-weight: 400;\">Eur Heart J<\/span><\/i><span style=\"font-weight: 400;\">. 2023. Published online2023. https:\/\/doi.org\/10.1093\/eurheartj\/ehad771.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Key Points This pre-specific subanalysis of NOAH-AFNET 6 found that those with long lasting atrial high rate episodes &gt;24 hours were more likely to develop atrial fibrillation (AF); there was no significant interaction found between the duration of the longest AHRE and the efficacy and safety of oral anticoagulation.<\/p>\n","protected":false},"author":40603,"featured_media":138161,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[883,8],"tags":[885,45,27,47,185],"ppma_author":[1029],"class_list":{"0":"post-138160","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-aha-2023","8":"category-news","9":"tag-aha-2023","10":"tag-conference","11":"tag-electrophysiology","12":"tag-featured","13":"tag-news","14":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138160","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138160"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138160\/revisions"}],"predecessor-version":[{"id":138162,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138160\/revisions\/138162"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138161"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138160"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138160"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138160"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}