Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE‐AF

Saczynski, Jane S.; Sanghai, Saket; Kiefe, Catarina I.; Lessard, Darleen M.; Marino, Francesca; Waring, Molly E.; Parish, David C.; Helm, Robert H.; Sogade, Felix; Goldberg, Robert J.; Gurwitz, Jerry H.; Wang, Weijia; Mailhot, Tanya; Bamgbade, Benita A.; Barton, Bruce; McManus, David D.

doi:10.1111/jgs.16178

Cited by 53 publications

(79 citation statements)

References 38 publications

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“…We used baseline data from the prospective multi-center study entitled "Systematic Assessment of Geriatric Elements in AF (SAGE-AF)". Details of participant recruitment and study protocols have been described previously [18][19][20]. Participants were recruited from three medical centers in Massachusetts and two medical centers in Central Georgia between 2015 and 2018.…”

Section: Study Populationmentioning

confidence: 99%

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

et al. 2020

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Background Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. Methods Patients (n = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either “excellent/very good”, “good”, and “fair/poor”. Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. Results Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53–3.03], ≥ 8 vs 1–4; OR: 1.37 [95% CI: 1.02–1.83], 5–7 vs 1–4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30–2.30]) or frail (OR: 6.81 [95% CI: 4.34–10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. Conclusions Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.

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Section: Study Populationmentioning

confidence: 99%

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

et al. 2020

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“…12 Some geriatric-dependent diseases are described as being the reasons for not prescribing oral anticoagulants, which suggests that prescribers may either be unaware of or deliberately ignoring the presence of these factors in clinical settings. 13 Meanwhile, the study of Nguyen et al suggested that the frailty status had little impact on antithrombotic prescriptions and also had no impact on anti-arrhythmic prescriptions. 14 One of the biggest problems in modern geriatrics is frailty syndrome, which is often mistakenly identified with multiple diseases.…”

Section: Discussionmentioning

confidence: 99%

<p>Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population</p>

Młynarska¹,

Młynarski²,

Marcisz³

et al. 2020

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Introduction: Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adultswe hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion. Methods: The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days. Results: Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010-0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm. Conclusion: Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.

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“…The SAGE-AF study has been previously described. ( Saczynski, Sanghai, & Kiefe, 2020 ) In brief, from June 2015 to June 2018, 1244 participants enrolled in SAGE-AF. Enrollment for SAGE-AF is complete and 2 year follow ups are ongoing.…”

Section: Methodsmentioning

confidence: 99%

Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

Bamgbade

Sanghai

McManus

et al. 2020

Archives of Gerontology and Geriatrics

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Background: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden. Methods: Patients with AF age ≥65 years with a CHA 2 DS 2 VASC risk score ≥ 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used. Results: Participants (N = 1244, 49 % female) were on average 76 ± 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26). Conclusions: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population.

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Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE‐AF

Cited by 53 publications

References 38 publications

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

<p>Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population</p>

Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

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