Treatment Patterns and Clinical Outcomes among Patients with Non-Valvular Atrial Fibrillation

Abstract

Background: Atrial fibrillation is the most common cardiac arrhythmia and increases the risk of stroke, heart failure, and mortality. NVAF accounts for most AF cases, with treatment focused on anticoagulation and rate or rhythm control. DOAC use has increased globally, but evidence from Bangladesh remains limited. This study aimed to assess treatment patterns and clinical outcomes among patients with NVAF in Bangladesh. Methods: A hospital-based observational study included 287 adults with NVAF at Naogaon Medical College, Naogaon, Bangladesh, from January 2025 to June 2026. Clinical characteristics, treatment patterns, and CHA₂DS₂-VASc scores were assessed. Patients were followed for 12 months for thromboembolic events, major bleeding, heart failure hospitalization, and mortality. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: Among 287 patients with NVAF, the mean age was 63.9 ± 11.1 years and 58.5% were male. Hypertension was the most common comorbidity. Oral anticoagulation was used in 82.2% of patients, including DOACs in 51.2% and warfarin in 31.0%; rate control was the predominant management strategy (72.5%). During 12 months of follow-up, 11.8% experienced a major clinical event, including stroke/TIA (4.9%), major bleeding (3.8%), and heart failure hospitalization (3.5%). Stroke/TIA was lower among anticoagulated patients than non-anticoagulated patients (3.0% vs 13.7%, p=0.004). Previous stroke/TIA, CHA₂DS₂-VASc ≥2, and absence of anticoagulation were independent predictors of stroke/TIA, while age ≥75 years and concomitant antiplatelet therapy independently predicted major bleeding. Conclusion: DOACs were the most commonly used anticoagulants, and rate control was the predominant strategy. Anticoagulation was associated with fewer stroke/TIA events, highlighting the importance of appropriate anticoagulation in NVAF management.