Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

J Thromb Thrombolysis. 2020 Jan;49(1):18-26. doi: 10.1007/s11239-019-01937-3.

Abstract

Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient's frailty status and anemia diagnosis.

Keywords: Atrial fibrillation; Comprehensive geriatric assessment; Frailty; New oral anticoagulant drugs; Older people.

MeSH terms

  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Atrial Fibrillation / drug therapy*
  • Cross-Sectional Studies
  • Female
  • Frailty
  • Health Services for the Aged*
  • Humans
  • Male
  • Patient Discharge*
  • Prospective Studies

Substances

  • Anticoagulants