Abstract
Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient’s frailty status and anemia diagnosis.
Highlights
Atrial fibrillation (AF) is the most common rhythm disorder among older patients
The aim of the study was to assess the prevalence of oral anticoagulant treatment in patients with non-valvular atrial fibrillation (NVAF) admitted to the geriatric ward, and to determine factors associated with oral anticoagulation at discharge
The majority of them was above 80 years of age (73.7%), and female (78.1%). 25.8% of the study group were on APTs and 58.9% on oral anticoagulants (OACs), mainly on VKAs (Fig. 1)
Summary
Atrial fibrillation (AF) is the most common rhythm disorder among older patients It has a substantial impact on both morbidity and mortality, and is a strong independent risk factor for stroke [1]. Prior to considering oral anticoagulant therapy in an older frail patient, a comprehensive geriatric assessment (CGA) should be performed to evaluate its risks and benefits [4]. Available data, regarding clinical profile and management of older patients with AF according to dependency, frailty and cognitive deterioration, are scarce. It is not known what is the impact of the assessment of these domains on the decision on the recommendation of anticoagulants in the case of patients hospitalized in a geriatric ward
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