Anticoagulant Therapy for Frail Patients with Atrial Fibrillation

Hori, Hiroshi; Fukuchi, Takeo; Sugawara, Hitoshi

doi:10.2169/internalmedicine.6077-20

Cited by 5 publications

(3 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Frail patients with atrial fibrillation have higher risks of incidental stroke, mortality and duration of hospitalisation than non-frail ones [ 35 ] and anticoagulants can improve the prognosis of frail individuals. Despite this, the prescription of anticoagulants is usually restricted in frail patients due to the risk of falls and bleeding complications [ 36 ]. A meta-analysis by Oqab et al comprising three studies on the prescription of anticoagulants in older adults with atrial fibrillation, concluded that frail patients were less likely to receive this medication when compared with non-frail ones [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Valdiviesso,

Amaral,

Moreira

et al. 2023

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction. Methods Participants in this cross-sectional study were recruited from a HF outpatients’ clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People. Results A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30). Conclusions The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.

show abstract

Section: Discussionmentioning

confidence: 99%

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Valdiviesso,

Amaral,

Moreira

et al. 2023

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Anticoagulant therapy is an important topic in geriatric medicine, introducing the importance of clinical-decision making tools [ 31 ]. In literature, the main reasons reported to refrain from the prescription of oral anticoagulant therapy in older people include age itself, current concomitant antiplatelet therapy, an increased risk of bleeding or risk of falls, cognitive impairment, functional impairment or difficulty in maintaining adequate INR values [ 32 ]. By contrast, given the lack of specific recommendations, the potential opposite risk is the prescription of such drugs only based on stroke risk scores and not accounting frailty condition of older adults with AF [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF)

et al. 2022

View full text Add to dashboard Cite

Background Literature suggests that different risks of mortality could influence physicians in prescribing or not anticoagulants in older patients with atrial fibrillation (AF). The Multidimensional Prognostic Index (MPI) can be considered a tool for the detection of multidimensional frailty. The aim of this cross-sectional study was to evaluate whether prescription patterns of oral anticoagulants exist, based on MPI values. Methods Older hospitalised patients (age ≥ 65 years) with non-valvular AF were included across 24 European centres. MPI was calculated using validated and standardised tools derived from a comprehensive geriatric assessment. Other functional and clinical information were collected to calculate indexes specific for haemorrhagic and thromboembolic risk in AF. Results Altogether, 2,012 participants affected by AF (mean age was 83.2 ± 7.5, range: 65–104 years), with a higher presence of women (57.0%), were included. Overall, 440 took vitamin K antagonists VKAs (22.0%), 667 (33.4%) direct oral anticoagulants (DOACs), whilst 44.6% did not take any anticoagulant treatment. Prescription of anticoagulants was associated with MPI values, with people taking anticoagulants having lower mean MPI values. Anticoagulant therapy was not used in 53.1% of the group with the highest risk of mortality, compared with 32.3% of those in the group with the lowest mortality risk. People with higher scores in MPI were less frequently treated with anticoagulant therapy, after adjusting for several potential confounders. Conclusions The EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) suggested that almost half of the older persons with AF do not receive anticoagulants and that MPI is an important determinant in prescribing or not anticoagulants. Trial Registration : https://clinicaltrials.gov/ct2/show/NCT02973984 KEY POINTS Atrial fibrillation is a common condition in older people. The data regarding the use of anticoagulants is mainly derived from randomised controlled trials that do not include a sufficient number of older frail people. Our study suggests that a consistent part of older people affected by atrial fibrillation was not treated with anticoagulants, in particular, older frail patients; however, it is unclear if this choice is supported or not by evidence. The prognostic evaluation through the multidimensional prognostic index could be useful information for the choice in the prescription of anticoagulants in older people affected by atrial fibrillation.

show abstract

“…The other component of the worsened outcomes in some of the lowest tertile groups was that these individuals were less likely to be prescribed indicated antithrombotic therapy. It is plausible that this prescribing reticence reflects concerns about antithrombotic therapy in the frail population 7 . This includes worries about falls risk and bleeding complications in more frail individuals.…”

Section: Anthropometric Parameters and Af Outcomes: A Path To Precisi...mentioning

confidence: 99%

Anthropometric parameters and atrial fibrillation outcomes: a path to precision medicine

Chattopadhyay

Pugh

Vassiliou

2022

European Journal of Preventive Cardiology

View full text Add to dashboard Cite

Anticoagulant Therapy for Frail Patients with Atrial Fibrillation

Cited by 5 publications

References 58 publications

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF)

Anthropometric parameters and atrial fibrillation outcomes: a path to precision medicine

Contact Info

Product

Resources

About