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. 2024 Jan-Dec:15:21501319241243005.
doi: 10.1177/21501319241243005.

Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation

Meaghan Costello  1   2 , Ericka E Tung  1 , Karen M Fischer  1 , Thomas M Jaeger  1
Affiliations

Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation

Meaghan Costello et al. J Prim Care Community Health. 2024 Jan-Dec.

Abstract

Objectives: To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation.

Methods: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes.

Results: A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001).

Conclusions: A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.

Keywords: anticoagulation; frailty; geriatric syndrome; older adult.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann. Intern. Med. 2007;146(12):857-867. - PubMed
    1. Granger CB, Alexander JH, McMurray JJ, et al.. Apixaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2011;365(11):981-992. - PubMed
    1. Gao X, Yang YM, Zhu J, Dai Y, Tan HQ, Investigators R-LC. [Dabigatran versus warfarin for the prevention of stroke in Chinese patients with nonvalvular atrial fibrillation: Chinese subpopulation analysis of RE-LY]. Zhonghua Xin Xue Guan Bing Za Zhi. 2016;44(11):929-934. - PubMed
    1. Giugliano RP, Ruff CT, Braunwald E, et al.. Edoxaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2013;369(22):2093-2104. - PubMed
    1. Patel MR, Mahaffey KW, Garg J, et al.. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N. Engl. J. Med. 2011;365(10):883-891. - PubMed

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