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
Multicenter Study
. 2023 Nov 2;52(11):afad216.
doi: 10.1093/ageing/afad216.

Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study

Alberto Pilotto  1   2 , Nicola Veronese  3 , Maria Cristina Polidori  4 , Timo Strandberg  5   6 , Eva Topinkova  7 , Alfonso J Cruz-Jentoft  8 , Carlo Custodero  2 , Mario Barbagallo  3 , Stefania Maggi  9 ; EUROSAF Study Investigators
Collaborators, Affiliations
Multicenter Study

Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study

Alberto Pilotto et al. Age Ageing. .

Abstract

Aims: Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk ratio of the anticoagulant treatments, considering the severity of frailty, determined by the multidimensional prognostic index (MPI).

Methods: In this European, multicentre, prospective study, older hospitalised patients (≥65 years) with non-valvular AF were followed-up for 12 months. Anticoagulants' use at discharge ascertained using medical records. MPI was calculated using tools derived from comprehensive geriatric assessment, classifying participants in robust, pre-frail or frail. Mortality (primary outcome); vascular events, including ischemic heart disease or ischemic stroke, hemorrhagic stroke or gastrointestinal bleedings (secondary outcomes).

Results: 2,022 participants (mean age 82.9 years; females 56.6%) were included. Compared with people not taking anticoagulants (n = 823), people using vitamin K antagonists (n = 450) showed a decreased risk of mortality (hazard ratio, HR = 0.74; 95% CI: 0.59-0.93), more pronounced in patients using direct oral anticoagulants (DOACs) (n = 749) (HR = 0.46; 95% CI: 0.37-0.57). Only people taking DOACs reported a significantly lower risk of vascular events (HR = 0.55; 95% CI: 0.31-0.97). The efficacy of DOACs was present independently from frailty status. The risk of gastrointestinal bleedings and hemorrhagic stroke did not differ based on the anticoagulant treatments and by MPI values.

Conclusions: Anticoagulant treatment, particularly with DOACs, was associated with reduced mortality in older people, without increasing the risk of hemorrhagic events, overall suggesting the importance of treating with anticoagulants older people with AF.

Keywords: atrial fibrillation; frailty; mortality; multidimensional prognostic index; older people; stroke.

PubMed Disclaimer

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare that no competing interests exist for this work.

Figures

Figure 1
Figure 1
Association between anticoagulation status at discharge and mortality, over 1 year of follow-up. Survival curves are reported with the correspondent 95% CIs
See this image and copyright information in PMC

References

    1. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 2014; 6: 213. - PMC - PubMed
    1. Polidori MC, Alves M, Bahat G. et al. Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines. Eur Geriat Med 2021; 13: 5–18. - PMC - PubMed
    1. Pilotto A, Veronese N, Polidori MC. et al. The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF). Ann Med 2022; 54: 2410–8. - PMC - PubMed
    1. Caldeira D, Nunes-Ferreira A, Rodrigues R, Vicente E, Pinto FJ, Ferreira JJ. Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr 2019; 81: 209–14. 10.1016/j.archger.2018.12.013. - DOI - PubMed
    1. Lee S, Monz BU, Clemens A, Brueckmann M, Lip GY. Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database. BMJ Open 2012; 2: e001768. - PMC - PubMed

Publication types