Abstract
Background: The prevalence of atrial fibrillation (AF) increases with age, reaching 10% among those above the age of 80. The safety and efficacy of using anticoagulation (AC) to prevent stroke among nonagenarians are not well understood, due underrepresentation of this cohort in landmark clinical trials of oral anticoagulants. We sought to explore readmission rates for all-cause, gastrointestinal bleeding, and acute cerebrovascular events for nonagenarians on AC for AF compared to patients younger than 90. Methods: By using the Nationwide Readmission Database (NRD) from 2010-2015 and ICD-9-CM codes, we identified patients hospitalized with diagnoses of AF and chronic AC, and excluded patients under age 18, those who died during the index admission, and those with pulmonary embolism, deep vein thrombosis or a prosthetic valve. Patients hospitalized in December for each calendar year were excluded to allow 30-day follow-up for all patients since the database resets annually. Chi-Square test was used to compare readmission rates between the two groups and a linear test was used to analyze the trend for AC use across years. Results: Our criteria identified a total of 1,456,114 patients, of whom 132,476 (9.0%) were ≥ 90 years old. Use of AC for AF among nonagenarians increased over the years of the study from 12.3% in 2010 to 22.7% in 2015 (p<0.001). Thirty-day readmission rates in nonagenarians vs. those < 90 were: all-cause - 16.9% vs. 17.2% (p=0.03), gastrointestinal bleeding - 0.5% vs. 0.4% (p<0.001), and acute cerebrovascular events - 0.8% vs. 0.5% (p<0.001). Conclusion: Although the differences were small, nonagenarians treated with AC for AF had a lower 30-day all-cause readmission rate but higher gastrointestinal bleeding and acute cerebrovascular event re-hospitalization rates. Further investigations are warranted to explore the benefit vs. risk of using AC in this vulnerable population of patients.
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