Abstract 251: Geriatric Syndromes Associated With Reduced Anticoagulant Use in Older Adults With Atrial Fibrillation

Abstract

Background: While guidelines recommend focusing primarily on stroke risk when considering anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. However, little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. Methods: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older adults. We included patients ≥67 years with 2 years of continuous Medicare fee-for-service enrollment and 1 inpatient or 2 outpatient AF diagnosis claims. We evaluated five geriatric syndromes: falls, activities of daily living impairment (ADL), instrumental activities of daily living impairment (IADL), cognitive impairment, and incontinence. We measured their prevalence and associations with anticoagulant use via log-binomial regression models adjusting for CHA2DS2-VASc score. Results: In this study of 779 patients with AF (median age 80 years, median CHA2DS2-VASc score 4), 83% (CI 79-86%) had ≥1 geriatric syndrome. Adjusting for stroke risk, lower rates of anticoagulant use were reported in those with ADL dependency (RR 0.87, CI 0.79-99), IADL dependency (RR 0.86, CI 0.77-0.98), and dementia (RR 0.72, CI 0.60-0.86). Conclusion: Most older patients with AF have at least one geriatric syndrome, and geriatrics syndromes are associated with less anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulants use in older adults. Since the benefits and harms of anticoagulants in this group are ill-defined, it is unclear if lower anticoagulant use is appropriate.