Presence of Geriatric Conditions Is Prognostic of Major Bleeding in Older Patients with Atrial Fibrillation: a Cohort Study

Abstract

Background: In older patients with atrial fibrillation (AF), physical, cognitive, and psychosocial limitations are prevalent. The prognostic value of these conditions for major bleeding is unclear.

Objective: To determine whether geriatric conditions are prospectively associated with major bleeding in older patients with AF on anticoagulation.

Design: Multicenter cohort study with 2-year follow-up from 2016 to 2020 in Massachusetts and Georgia from cardiology, electrophysiology, and primary care clinics.

Participants: Diagnosed with AF, age 65 years or older, CHA₂DS₂-VASc score of 2 or higher, and taking oral anticoagulant (n=1,064). A total of 6507 individuals were screened.

Main measures: A six-component geriatric assessment of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Main outcome was major bleeding adjudicated by a physician panel.

Key results: At baseline, participants were, on average, 75.5 years old and 49% were women. Mean CHA₂DS₂-VASc score was 4.5 and the mean HAS-BLED score was 3.3. During 2.0 (± 0.4) years of follow-up, 95 (8.9%) participants developed an episode of major bleeding. After adjusting for key covariates and accounting for competing risk from death, cognitive impairment (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.02-2.56) and frailty (HR 2.77, 95% CI 1.38-5.58) were significantly associated with the development of major bleeding.

Conclusions: In older patients with AF taking anticoagulants, cognitive impairment and frailty were independently associated with major bleeding.