Clinical characteristics of super-elderly patients with atrial fibrillation: from the Fushimi AF registry

Abstract

Purpose: Atrial fibrillation (AF) increases as the population ages, but data regarding super-elderly patients (≥85 years of age) are quite limited. The purpose of this study is to investigate clinical characteristics of super-elderly patients with AF. Methods: The Fushimi AF registry, a community-based prospective survey was designed to enroll all of the AF patients in Fushimi-ku, Kyoto, Japan. Fushimi-ku is densely populated with a total population of 283,000, and is assumed to represent a typical urban community in Japan. On the basis of the general prevalence of AF in the Japanese (0.6%), we estimated the total number of AF patients as 1,700. A total of 76 institutions, a large proportion of which were private clinics, participated in the study. At present, we have enrolled 3,378 patients (1.2% of total population) from March 2011 to December 2012. We divided the entire cohort into two groups, super-elderly group (≥85 years of age; n=547, 16.2% of total) and others (n=2,831), and compared the clinical backgrounds between them. Results: Super-elderly patients were more often female (67.1% vs. 35.9%), and more lightweight (body weight 48.6 kg vs 60.5 kg, body mass index 21.0 vs 23.2). The mean CHADS2 score and CHA2DS2-VASc score were higher in the super-elderly group (2.83 vs. 1.95; P<0.01, and 4.62 vs 3.20; P<0.01). Heart failure and previous stroke were more in super-elderly patients (41.3% vs. 24.9%; P<0.01, and 28.7% vs. 17.8%; P<0.01, respectively), whereas dyslipidemia and diabetes mellitus were less (29.1% vs. 45.0%; P<0.01, and 17.0% vs. 24.4%; P<0.01, respectively). There were no significant difference in the prevalence of hypertension, coronary artery disease and peripheral artery disease between groups. Chronic kidney disease was more in super-elderly patients (39.6% vs. 23.6%; P<0.01). Super-elderly patients experienced more episodes of major bleeding (3.66% vs. 1.59%; P<0.01), and received lower warfarin prescription (36.8% vs. 50.2%; P<0.01). Conclusions The Fushimi AF Registry provides a unique snapshot of current realworld AF management in an urban community in Japan. Super-elderly patients with AF have higher risk profiles for thromboembolism, whereas they experience more episodes of major bleeding. Indication and dose selection of anticoagulation of super-elderly patients should be carefully determined.