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
. 2023 Feb;71(2):394-403.
doi: 10.1111/jgs.18079. Epub 2022 Oct 23.

Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation

Weijia Wang  1 , Darleen Lessard  2 , Catarina I Kiefe  2 , Robert J Goldberg  2 , David Parish  3 , Robert Helm  4 , Katherine Trymbulak  5 , Jordy Mehawej  2 , Hawa Abu  2 , Benita A Bamgbade  6 , Robert Hayward  7 , Joel Gore  1 , Jerry H Gurwitz  1   2   8 , David D McManus  1 , Jane S Saczynski  6
Affiliations

Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation

Weijia Wang et al. J Am Geriatr Soc. 2023 Feb.

Abstract

Background: In older patients with atrial fibrillation (AF), cognitive impairment and frailty are prevalent. It is unknown whether the risk and benefit of anticoagulation differ by cognitive function and frailty.

Methods: A total of 1244 individuals with AF with age ≥65 years and a CHADSVASC score ≥2 were recruited from clinics in Massachusetts and Georgia between 2016 and 18 and followed until 2020. At baseline, frailty status and cognitive function were assessed. Hazard ratios of anticoagulation on physician adjudicated outcomes were adjusted by the propensity for receiving anticoagulation and stratified by cognitive function and frailty status.

Results: The average age was 75.5 (± 7.1) years, 49% were women, and 86% were prescribed oral anticoagulants. At baseline, 528 (42.4%) participants were cognitively impaired and 172 (13.8%) were frail. The adjusted hazard ratios of anticoagulation for the composite of major bleeding or death were 2.23 (95% confidence interval: 1.08-4.61) among cognitively impaired individuals and 0.94 (95% confidence interval: 0.49-1.79) among cognitively intact individuals (P for interaction = 0.08). Adjusted hazard ratios for anticoagulation were 1.84 (95% confidence interval: 0.66-5.13) among frail individuals and 1.39 (95% confidence interval: 0.84-2.40) among not frail individuals (P for interaction = 0.67).

Conclusion: Compared with no anticoagulation, anticoagulation is associated with more major bleeding episodes and death in older patients with AF who are cognitively impaired.

Keywords: anticoagulation; atrial fibrillation; bleeding; cognitive function; frailty.

PubMed Disclaimer

Conflict of interest statement

DDM has received direct research or grant support from Apple Computer, Fitbit, Bristol-Myers Squibb, Boerhingher-Ingelheim, Pfizer, Samsung, Philips Healthcare, Biotronik, and Flexcon. DDM has received consultancy fees from the Heart Rhythm Society, Bristol-Myers Squibb, Pfizer, Flexcon, Boston Biomedical Associates. DDM serves on the Steering Committee of the GUARD AF study and Advisory Committee for the Fitbit Heart Study. The remaining authors have nothing to disclose.

DDM has received research grant support from Apple Computer, Bristol-Myers Squibb, Boeringher-Ingelheim, Pfizer, Samsung, Philips Healthcare, and Biotronik, has received consultancy fees from Bristol-Myers Squibb, Pfizer, Flexcon, and Boston Biomedical Associates, and has investor equity in Mobile Sense Technologies, Inc. (CT).

This work was supported by grant R01HL126911 from the National Heart, Lung, and Blood Institute. DDM’s time was also supported by grants R01HL137734, R01HL137794, R01HL13660, and R01HL141434 from the National Heart, Lung and Blood Institute.

Conflict of interest

Other authors have no conflicts.

Figures

Figure 1.
Figure 1.
Absence of major bleeding or death, by anticoagulation status, stratified by cognitive function. The survival function was adjusted by the propensity score to receiving oral anticoagulation (OAC).
Figure 2.
Figure 2.
Hazard ratios of anticoagulation for bleeding, death, and stroke among older patients with atrial fibrillation by cognitive function. Hazard ratios were adjusted for the propensity score to receive oral anticoagulation. . The reference group was patients who did not receive anticoagulation.
Figure 3.
Figure 3.
Hazard ratios of anticoagulation for bleeding, death, and stroke among older patients with atrial fibrillation by frailty status. Hazard ratios were adjusted for the propensity score to receive oral anticoagulation. The reference group was patients who did not receive anticoagulation.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Jelena Kornej, Börschel Christin S, Benjamin Emelia J, Schnabel Renate B. Epidemiology of Atrial Fibrillation in the 21st Century. Circulation Research 2020; 127: 4–20. - PMC - PubMed
    1. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach: The Euro Heart Survey on Atrial Fibrillation. Chest 2010; 137: 263–72. - PubMed
    1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal 2021; 42: 373–498. - PubMed
    1. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk of Major Bleeding in Patients With Atrial Fibrillation: The Euro Heart Survey. Chest 2010; 138: 1093–100. - PubMed
    1. Wang W, Saczynski J, Lessard D, et al. Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE-AF study. Journal of Cardiovascular Electrophysiology 2019; 30: 2508–15. - PMC - PubMed

Publication types