Risk of ischemic stroke and direct oral anticoagulants persistence for virtual vs in-person follow-up in atrial fibrillation – a nationwide matched cohort study
S K Nielsen, A Meddis, P Blanche, M Hashiba, U B Kirk, L Kayser, L Al-Ansary, N Nouhravesh, A Holt, M LambertsAbstract
Background
The safety and efficacy of virtual follow-up compared with in-person care for patients with atrial fibrillation (AF) remain uncertain.
Purpose
This study aimed to compare persistence to direct oral anticoagulants (DOACs) and clinical outcomes including ischemic stroke and bleeding, between patients managed with virtual versus in-person follow-up.
Methods
All individuals in Denmark aged 50–90 years diagnosed with AF for the first time from April 2019 to January 2023 registered in Danish registries were identified. Patients followed-up virtually were matched to patients followed-up in-person. Patients were matched on patient characteristics e.g. age and sex and visit related parameters such as time from diagnosis to visit. Start of follow-up began 14 days after their exposure visit. We calculated persistence during 24 months of follow-up, and the 1-year risk of stroke and safety outcomes such as bleeding.
Results
In our matched population 4 734 patients were followed-up virtually (median age: 74 years, 58.5% male), and 8 904 matched controls were followed-up in-person (median age: 74 years, 58.3% male). The probability of being persistent to DOACs at 24 months was 82.9% (95% CI, 81.5% to 84.3%) for the virtual group and 84.1% (95% CI, 83.2% to 85.0%) for the in-person group. The virtual group had an estimated 1.7% 1-year risk of ischemic stroke, while the risk was 0.8% for the in-person group. Yielding a risk difference (RD) of 0.9% (95% CI, 0.5% to 1.3%). The virtual group was not found to have a significantly higher risk of bleeding (RD, 0.3%, 95% CI, -0.4% to 1.0%).
Conclusions
Virtual follow-up after AF was associated with an increased risk of ischemic stroke within 1-year compared to patients followed-up in-person. We found no significant difference in risk of bleeding nor a clinically relevant difference in DOAC persistence between groups.Persistence to DOACs within 24 months1-year risk of clinical outcomes