Abstract 17774: Utilization of Oral Anticoagulants and Antiplatelets in Nursing Home Residents With Atrial Fibrillation

Abstract

Background: Prior research reported underutilization of oral anticoagulants (OAC) in nursing home (NH) residents with atrial fibrillation (AF), but these studies may not have sufficiently addressed whether utilization was appropriate given the multimorbidity and limited life expectancy, and whether these patients are receiving antiplatelet (APT) as the alternative stroke prophylaxis. Methods: We conducted a retrospective cohort study using electronic health records and Minimum Data Set resident clinical assessment from 735 NHs among long-stay NH residents (≥100 days) with a diagnosis of AF. Because there was increased awareness of thrombotic events during the COVID-19 pandemic, we assessed OAC and APT use in 30 days prior to 1/1/2020 and 1/1/2021 was measured from medication order records. Results: Our study sample included 8135 long-stay residents with AF (mean age 78, 58% women, 1.6% American Indian/Asian/Native Hawaiian, 14% Black, 2.4% Hispanic, 80% White, 2% Other). Dementia was the most common comorbidity (51%) followed by diabetes (40%), heart failure (36%), chronic kidney disease (32%), and stroke (19%). One in 3 residents had moderately or severely impaired cognitive function. One third of the residents received APT only (mostly aspirin) and half did not receive APT or OAC in either year. The proportion of patients who did not receive OAC increased in 2021 (Figure). Conclusion: Only 13% of NH residents with AF received OAC and 37% received APT only. Given APT does not reduce the risk of AF-related stroke but has similar bleeding risk as OAC, there is an urgent need to develop anticoagulant standards for NH residents that address multimorbidity, life expectancy and patient preferences.