Real‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study

Biteker, Murat; Başaran, Özcan; Doğan, Volkan; Altun, İbrahim; Karadeniz, Fatma Özpamuk; Tekkeşin, Ahmet İlker; Çakıllı, Yasin; Türkkan, Ceyhan; Hamidi, Mehmet Mustafa; Demir, Vahit; Gürsoy, Mustafa Ozan; Öztürk, Müjgan Tek; Aksan, Gökhan; Seyis, Sabri; Ballı, Mehmet; Alıcı, Mehmet Hayri; Bozyel, Serdar

doi:10.1111/jgs.14855

Cited by 25 publications

(13 citation statements)

References 37 publications

(57 reference statements)

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“…4,14,23,24 However, survey data showed that AF patients, aged ≥80 years are more likely to receive antiplatelet medication than younger patients. 25 In the present data, only approximately one-quarter of patients diagnosed with AF received OAC before death, and centenarians with AF received significantly less anticoagulant therapy than younger age groups. Nevertheless, the rate of anticoagulation therapy increased over the study period in all age groups, which might be explained by the introduction of NOACs onto the market and with rates of comorbidities.…”

Section: Discussioncontrasting

confidence: 42%

Atrial fibrillation and medication treatment among centenarians: Are all very old patients treated the same?

Kreutz

Schmidt

Dräger

et al. 2018

Geriatrics Gerontology Int

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Aim Evidence on antithrombotic therapy use in centenarians diagnosed with atrial fibrillation (AF) is sparse. Our objective was to investigate a possible underprescribing in centenarians relative to younger cohorts of the oldest‐old. We assumed lower AF rates; and, within AF patients, lower use of anticoagulants in those who died as centenarians (aged ≥100 years) than in those who died aged in their 80s (≥80 years) or 90s (≥90 years). Methods The present study was a quarterly structured cohort study over the 6 years before death using administrative data from German institutionalized and non‐institutionalized insured patients (whole sample n = 1398 and subsample of AF patients n = 401 subclassified according to age‐of‐death groups [≥80, ≥90, ≥100 years]). AF, medication, stroke risk (Congestive heart failure; Hypertension; 2 × Age ≥75 years; Diabetes mellitus; 2 × Stroke; Vascular disease; Age 65–74 years; Sex [female] (CHA2DS2‐VASc)) and risk of major bleeding (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile International Normalized Ratio [omitted in the present analysis]; Elderly; Drugs or alcohol (HAS‐BLED)) were calculated. Generalized estimation equations were used to model the trajectories. Results Half a year before death (T1), AF rates were higher in patients aged ≥80 years (31.8%) and ≥90 years (30.6%) compared with patients aged ≥100 years (22.4%), whereas there were no significant differences between age groups 6 years before death (T0). Of all AF patients with AF at T1, 26.7% received anticoagulants; 11.2% vitamin K antagonists; 15.7% non‐vitamin K antagonist oral anticoagulants; and 17.5% platelet inhibitors; yet 58.1% received none of these drugs. Centenarians received significantly fewer anticoagulants compared with the other age groups. Prescriptions of anticoagulants were not associated with CHA2DS2‐VASc with and without adjustment for HAS‐BLED. Conclusions The present findings highlight the need for more appropriate use of anticoagulation therapy in older patients, as well as for new treatment guidelines taking the heterogeneity of very old patients into account. Geriatr Gerontol Int 2018; 18: 1634–1640.

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Section: Discussioncontrasting

confidence: 42%

Atrial fibrillation and medication treatment among centenarians: Are all very old patients treated the same?

Kreutz

Schmidt

Dräger

et al. 2018

Geriatrics Gerontology Int

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“…Several patient characteristics are associated with lower rates of OAC prescribing including older age, female sex, antiplatelet use, and comorbid conditions . Beyond these clinical factors, providers frequently cite actual or perceived fall risk and age‐related impairments as reasons for AC withholding .…”

mentioning

confidence: 99%

“…7,8 Several patient characteristics are associated with lower rates of OAC prescribing including older age, female sex, antiplatelet use, and comorbid conditions. [9][10][11] Beyond these clinical factors, providers frequently cite actual or perceived fall risk and age-related impairments as reasons for AC withholding. 12,13 Studies have shown that physician perceptions of stroke and bleeding risk in patients with AF do not consistently relate to validated risk score estimations.…”

mentioning

confidence: 99%

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

Saczynski

Sanghai

Kiefe

et al. 2019

J American Geriatrics Society

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OBJECTIVES Oral anticoagulants are the cornerstone of stroke prevention in high‐risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN Cross‐sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE‐AF) prospective cohort study. SETTING Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS Participants with AF age 65 years or older, CHA2DS2‐VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65‐74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS A six‐component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre‐frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51‐1.09; frail OR = .69; 95% CI = .35‐1.36; social isolation OR = .90; 95% CI = .52‐1.54; depression OR = .79; 95% CI = .49‐1.27; visual impairment OR = .98; 95% CI = .65‐1.48; and hearing impairment OR = 1.05; 95% CI = .71‐1.54). CONCLUSION Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147–154, 2019

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“…Frailty, chronic renal disease and polypharmacy are the main contributors of elevated embolic and bleeding risk in these patients that have to be taken into consideration when making a decision on OAC therapy 11 . We showed that physicians tend to prescribe more OAC for elderly NVAF patients if they had elevated risk score for stroke and lower risk score for bleeding 10 . However, currently available risk scores are far from perfect.…”

Section: Switching Among Oral Anticoagulants: Is It Logical?mentioning

confidence: 87%

“…Elderly patients have an increased risk for stroke, however, OACs were generally less prescribed to these patients because of comorbidities 10 . Frailty, chronic renal disease and polypharmacy are the main contributors of elevated embolic and bleeding risk in these patients that have to be taken into consideration when making a decision on OAC therapy 11 .…”

Section: Switching Among Oral Anticoagulants: Is It Logical?mentioning

confidence: 99%

Switching among oral anticoagulants: is it logical?

Başaran

Biteker

2019

Current Medical Research and Opinion

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Real‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study

Cited by 25 publications

References 37 publications

Atrial fibrillation and medication treatment among centenarians: Are all very old patients treated the same?

Atrial fibrillation and medication treatment among centenarians: Are all very old patients treated the same?

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

Switching among oral anticoagulants: is it logical?

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