Long-term individual and population functional outcomes in older adults with atrial fibrillation

Abstract

Background: While guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. Methods: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants ≥65 years with two years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last two years, receiving help with activities of daily living (ADL) or instrumental activities of daily living (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use adjusting for ischemic stroke risk (i.e., CHA2DS2-VASc score). Results: In this study of 779 participants with AF (median age 80 years, median CHA2DS2-VASc score 4), 82% had ≥1 geriatric syndrome. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairment, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect -3.7%; 95% CI -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia. Conclusion: Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.