0456: Therapeutic management in ambulatory elderly patients with atrial fibrillation: the S.AGES cohort

Abstract

Few data on therapeutic management of patients over 80 years with nonvalvular atrial fibrillation (AF) are available in general population. The objectives of the AF-S.AGES cohort (Sujets AGES) were to describe real-life therapeutic management of non-institutionalized elderly subjects with AF according to age groups, i.e., 65-79 and ≥80 years and to determine factors associated with anticoagulant treatment. General practitioners recruited 1072 patients aged >65 years old between 2009 and 2011. General characteristics were first evaluated in the overall sample and according to age groups and use of anticoagulant treatment at inclusion. Mean age was 78.0 (SD 6.5) years and 42% were older than 80 years. In the overall sample, 19% of patients had paroxysmal AF, 15% persistent, 56% permanent and for 10% AF type was unknown. Vitamin K antagonists (VKA) were used in 77% of patients, antiplatelet therapy in 17% and 12% of patients did not receive any antithrombotic treatment. There were no differences between age-groups (< 80 or ≥80 years) for VKA (78 vs. 76%, p=0.58). Rate control drugs were more frequently used (55%) than rhythm control drugs (37%). Class I and class II antiarrhythmic drugs were less often used in octogenarians than in younger patients (5.6% vs. 12.3%, p<0.001 and 36 vs. 41%, p<0.05). Among patients ≥80 years old, VKA use was associated with permanent AF younger age and cancer. Among patients < 80 years old, the use of VKA was associated with permanent AF and preserved functional autonomy. HAS-BLED and HEMORR2HAGES scores were associated with non-use of VKA in subjects ≥80 and < 80 years, CHADS2 and CHA2DS2-VASc scores were not associated with VKA use in both groups. We observed a higher use of anticoagulant therapy in elderly AF outpatients even after 80 years when compared with previous studies. These results suggest that recent international guidelines are better implemented in the elderly population.