Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;34(9):2185-2194.
doi: 10.1007/s40520-022-02140-w. Epub 2022 May 11.

Influence of atrial fibrillation subtypes on anticoagulant therapy in a high-risk older population: the FAI project

Antonio Di Carlo  1 , Fabio Mori  2 , Domenico Consoli  3 , Leonardo Bellino  4 , Augusto Zaninelli  5 , Marzia Baldereschi  6 , Maria Grazia D'Alfonso  2 , Chiara Gradia  3 , Alessandro Cattarinussi  7 , Bruno Sgherzi  8 , Giovanni Pracucci  7 , Benedetta Piccardi  9 , Bianca Maria Polizzi  10 , Domenico Inzitari  6   7 ; National Research Program: Progetto FAI. La Fibrillazione Atriale in Italia
Affiliations

Influence of atrial fibrillation subtypes on anticoagulant therapy in a high-risk older population: the FAI project

Antonio Di Carlo et al. Aging Clin Exp Res. 2022 Sep.

Abstract

Background and aim: Benefits of oral anticoagulants (OAC) in atrial fibrillation (AF) patients with moderate-to-high risk of stroke are independent of AF pattern. We evaluated whether AF clinical subtype influenced OAC use in a representative sample of the Italian older population.

Methods: A cross-sectional examination of all subjects aged 65 + years from three general practices in northern, central, and southern Italy started in 2016. A double-screening procedure was followed by clinical and ECG confirmation. Patients were categorized as having paroxysmal, persistent, or permanent AF. OAC use was evaluated in confirmed AF patients.

Results: The sample included 6016 subjects. Excluding 235 non-eligible, participation was 78.3%, which left 4528 participants (mean age 74.5 ± 6.8 years, 47.2% men). Overall, 319 AF cases were identified: 43.0% had paroxysmal, 21.3% persistent, and 35.7% permanent AF. Frequency of OAC therapy was 91.2% in permanent, 85.3% in persistent, and only 43.0% in paroxysmal AF (P < 0.001). In multivariate analysis, controlled for baseline variables and risk scales, persistent and permanent AF were associated with a significant increase in the likelihood of receiving OAC compared with paroxysmal AF (P < 0.001). This was confirmed for permanent AF also in multivariate analyses considering separately vitamin K antagonists or direct-acting oral anticoagulants (OR, 4.37, 95% CI, 2.43-7.85; and 1.92, 95% CI, 1.07-3.42, respectively) and for persistent AF and direct-acting oral anticoagulants (OR, 4.33, 95% CI, 2.30-8.15).

Conclusions: In a population-based survey, AF pattern was an independent predictor of OAC treatment. Paroxysmal AF is still perceived as carrying a lower risk of vascular events.

Keywords: Anticoagulants; Atrial fibrillation subtypes; Older population; Thromboembolism.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest to report for this article.

Figures

Fig. 1
Fig. 1
Frequency (%) of antithrombotic therapy by CHA2DS2-VASc score in total sample and by atrial fibrillation subtypes
Fig. 2
Fig. 2
Frequency (%) of antithrombotic therapy by HAS-BLED score in total sample and by atrial fibrillation subtypes
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–847. doi: 10.1161/CIRCULATIONAHA.113.005119. - DOI - PMC - PubMed
    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–2375. doi: 10.1001/jama.285.18.2370. - DOI - PubMed
    1. Björck S, Palaszewski B, Friberg L, et al. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke. 2013;44:3103–3108. doi: 10.1161/STROKEAHA.113.002329. - DOI - PubMed
    1. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27:949–953. doi: 10.1093/eurheartj/ehi825. - DOI - PubMed
    1. Di Carlo A, Bellino L, Consoli D, et al. Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: the FAI Project. Europace. 2019;21:1468–1475. doi: 10.1093/europace/euz141. - DOI - PubMed