Net clinical benefit of anticoagulant treatments in elderly patients with nonvalvular atrial fibrillation: Experience from the real world

Alnsasra, Hilmi; Haim, Moti; Senderey, Adi Berliner; Reges, Orna; Leventer‐Roberts, Maya; Arnson, Yoav; Leibowitz, Morton; Hoshen, Moshe; Avgil-Tsadok, Meytal

doi:10.1016/j.hrthm.2018.08.016

Cited by 41 publications

(28 citation statements)

References 20 publications

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“…Albeit the net clinical benefit of anticoagulant treatment even in very old patients with NVAF is positive, a large proportion of older patients are not treated with OACs [15][16][17]. It was confirmed also by our study-41.1% of patients with NVAF admitted to the geriatric department did not receive OACs.…”

Section: Discussionsupporting

confidence: 75%

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Wojszel

Kasiukiewicz

2019

J Thromb Thrombolysis

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Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient's frailty status and anemia diagnosis.

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Section: Discussionsupporting

confidence: 75%

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Wojszel

Kasiukiewicz

2019

J Thromb Thrombolysis

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“…Atrial fibrillation (AF) is the most common cardiac arrhythmia and affects approximately 10 million individuals in China [ 1 ]. The incidence and prevalence of AF increase with age, and it has a striking impact on the morbidity and mortality in older age groups (> 75 years old) [ 2 , 3 ]. Catheter ablation (CA) is an effective treatment for AF in younger patients; also, some recent studies showed that CA is safe and effective in elderly patients [ 2 , 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China

Chen

Liu

Jin

et al. 2019

J Interv Card Electrophysiol

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Purpose Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using secondgeneration cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies. Methods Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients. Results A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups. Conclusions CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.

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“…), namely from France, Germany, Italy and the United Kingdom was found in 47.8 %, 44.2 %, 46.1 % and 65.4 %, respectively (30). In a large Israeli study (13), the value of TTR ≥ 60 % was observed only in 20.0 % of 75-84 year-old patients and in 15.5 % of patients over 84 years. Out of 4,772 AF patients maintained in the Danish registry, 65.6 % had the value of TTR below 70 % while among patients with prior value of TTR ≥ 70 %, there was only a proportion of 55.7 % who yielded the same value during the following year (31).…”

Section: Discussionmentioning

confidence: 92%

“…A little later, these authors (12) found the warfarinisation rate to be 45 % at discharge among 452 AF patients at mean age of 82 years (hospitalised at acute medical and geriatric departments in 2013-2014), while warfarin was the leading oral anticoagulant (prescribed in 85 % of patients on oral anticoagulation). In Israel, warfarin was recommended in 17.4 % and NOAC in 25.0 % of 11,760 patients fi rst diagnosed with AF at age over 74 in years 2013-2015 (13). In Canada (14), warfarin was the most commonly used anticoagulant (58 % of anticoagulated outpatients with median age of 78 years) in 2013.…”

Section: Discussionmentioning

confidence: 99%

Traditional thromboprophylaxis in elderlies with atrial fibrillation: What we can achieve in real life

M¹,

Németh²,

Drobná³

et al. 2019

BLL

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OBJECTIVES: To investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fi brillation (AF). BACKGROUND: AF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODS: The study was based on multicentric observational Slovak audit of atrial fi brillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTS: At hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSION: Warfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).

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Net clinical benefit of anticoagulant treatments in elderly patients with nonvalvular atrial fibrillation: Experience from the real world

Cited by 41 publications

References 20 publications

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study

Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China

Traditional thromboprophylaxis in elderlies with atrial fibrillation: What we can achieve in real life

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