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. 2024 Jul 28;21(7):723-732.
doi: 10.26599/1671-5411.2024.07.003.

Clinical profile and outcomes in very elderly patients with atrial fibrillation anticoagulated with rivaroxaban: data from the EMIR study

Francisco Marín  1 , Manuel Anguita Sánchez  2 , Iñaki Lekuona  3 , Marcelo Sanmartín Fernández  4 , Vivencio Barrios  5 , Carlos Perez Muñoz  6 , Juan Cosín-Sales  7 , Alejandro I Pérez Cabeza  8 , Vanesa Roldán Schilling  9 , Carles Rafols Priu  10 , Esteban Orenes-Piñero  11 , María Asunción Esteve-Pastor  1
Affiliations

Clinical profile and outcomes in very elderly patients with atrial fibrillation anticoagulated with rivaroxaban: data from the EMIR study

Francisco Marín et al. J Geriatr Cardiol. .

Abstract

Objectives: To analyze the clinical profile, adequacy of treatment with rivaroxaban and outcomes in octogenarians with atrial fibrillation (AF), taking rivaroxaban in clinical practice.

Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before being included. Data were analyzed according to age (≥ 80 vs. < 80 years) at baseline.

Results: Out of 1433 patients, 453 (31.6%) were octogenarians at baseline. Compared to younger patients, octogenarians had more comorbidities, higher CHA2DS2-VASc (4.5 ± 1.3 vs. 3.0 ± 1.4; P < 0.001) and HAS-BLED scores (2.0 ± 1.0 vs. 1.4 ± 1.0; P < 0.001). Overall, the dose of rivaroxaban was adequately prescribed in 83.4% of patients, but more frequently in the younger population (71.1% vs. 89.1%; P = 0.039). After a mean follow-up of 2.2 ± 0.6 years, annual rates of stroke + systemic embolism + transient ischemic attack, MACE, cardiovascular death and major bleeding were 1.03%, 1.24%, 1.03% and 1.75%, respectively, in octogenarian patients. Except for progressive heart failure death and major bleeding, rates of outcomes in octogenarians were similar compared to younger patients. In octogenarians, the concomitant use of antiplatelet agents and non-severe dementia were independently associated with the development of ischemic stroke, whereas previous coronary revascularization and heart failure with MACE, and higher HAS-BLED score with major bleeding.

Conclusions: In clinical practice, around one third of patients taking rivaroxaban are octogenarians. These patients have many comorbidities and a high thromboembolic risk. Despite that, rates of adverse events remain low. Rivaroxaban is adequately prescribed in the majority of octogenarians.

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Conflict of interest statement

Francisco Marín has received consultancy/lecturing fees from Bayer, Boehringer Ingelheim, Pfizer, Bristol Myers Squibb, Daiichi Sankyo and AFNET. Manuel Anguita Sánchez has received funding for consulting and conference services from Bayer, Daiichi-Sankyo and Pfizer. Iñaki Lekuona has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo and Pfizer-BMS. Marcelo Sanmartin Fernández has received speaker and advisory fees from the following companies in the past 3 years: Bayer, Boehringer Ingelheim, BMS and Pfizer. Vivencio Barrios has received consultancy/lecture fees from Bayer, BMS/Pfizer, Boehringer Ingelheim and Daiichi Sankyo. Juan Cosín-Sales has received consultancy/lecture fees from Bayer, BMS/Pfizer, Boehringer Ingelheim and Daiichi Sankyo. Alejandro I. Pérez Cabeza has received personal fees for educational activities or participation on boards from Daiichi Sankyo, Bayer, Boehringer Ingelheim and Bristol Myers Squibb. Vanesa Roldán Schilling has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo and Pfizer-BMS. Carles Rafols Priu is an employee Bayer Hispania SL. Carlos Pérez Muñoz, Esteban Orenes-Piñero and María Asunción Esteve Pastor declared no personal conflict of interest or financial fees related with the manuscript.

Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Adequacy of dosage of rivaroxaban during the follow-up.
See this image and copyright information in PMC

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