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Observational Study
. 2018 Apr 26:13:749-756.
doi: 10.2147/CIA.S159373. eCollection 2018.

Hospitalized frail elderly patients - atrial fibrillation, anticoagulation and 12 months' outcomes

Niklas Ekerstad  1   2 , Thomas Karlsson  3 , Sara Söderqvist  4 , Björn W Karlson  4   5
Affiliations
Observational Study

Hospitalized frail elderly patients - atrial fibrillation, anticoagulation and 12 months' outcomes

Niklas Ekerstad et al. Clin Interv Aging. .

Abstract

Background and objective: Multiple chronic conditions and recurring acute illness are frequent among elderly people. One such condition is atrial fibrillation (AF), which increases the risk of stroke up to fivefold. The aim of this study was to investigate the prevalence of AF among hospitalized frail elderly patients, their use of anticoagulation and their 12-month outcomes.

Patients and methods: This was a clinical observational study of acutely hospitalized frail patients over the age of 75 years. The CHA2DS2-VASc Score was used to evaluate ischemic stroke risk in patients with AF. Clinically relevant outcomes were the composite of ischemic stroke and/or bleeding within 12 months, which was considered as primary in the analysis, ischemic stroke/transient ischemic attack (TIA), mortality, bleeding and hospital care consumption. Student's t-test, Fisher's exact test, Mann-Whitney U test and a Cox proportional hazards model were used for the analyses.

Results: The prevalence of AF was 47%, and 63% of them were prescribed an anticoagulant. AF patients without anticoagulation were older, more often females, more often in residential care, and they had worse Mini Nutritional Assessment and activities of daily living scores. Of the patients without anticoagulation, 56% had a documented contraindication. In univariate analysis, there were significantly more events among AF patients without anticoagulation regarding the composite outcome of ischemic stroke and/or bleeding (hazard ratio [HR] 3.65, 95% CI = 1.70-7.86; p < 0.001). When adjusting for potential confounders in Cox regression analysis, the difference remained significant (HR 4.54, 95% CI = 1.83-11.25; p = 0.001).

Conclusion: The prevalence of AF in a hospitalized frail elderly population was 47%. Of these, 63% were prescribed anticoagulation therapy. Almost half of the patients without stroke prophylaxis had no documented contraindication. At 1 year, there were significantly more events in terms of ischemic stroke and/or bleeding among AF patients without anticoagulation therapy than among those with.

Keywords: anticoagulants; atrial fibrillation; frail elderly; outcomes; patient safety.

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Conflict of interest statement

Disclosure Dr Björn W Karlson is an employee of AstraZeneca. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart. Note: AF diagnosis at index includes paroxysmal, persistent and permanent AF. Abbreviation: AF, atrial fibrillation.
Figure 2
Figure 2
Distribution of CHA2DS2-VASc score in patients with atrial fibrillation. Note: The distribution of CHA2DS2-VASc score in patients receiving anticoagulation (blue) and patients not receiving anticoagulation (green). Abbreviation: AC, anticoagulation.
See this image and copyright information in PMC

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