Highlights
- •Atrial fibrillation represents a major cause of mortality in older people.
- •Frail and oldest-old patients are rarely included in clinical trials.
- •Frail anticoagulated patients survived longer that not-anticoagulated ones.
- •The risk of clinically relevant bleeding was not significantly increased.
- •Comprehensive geriatric assessment may be useful in anticoagulation decision making.
Abstract
Background
Atrial Fibrillation (AF) represents a major cause of mortality and morbidity in older
people; however, oldest-old frail patients are usually excluded from clinical trials.
Aim of the study is to evaluate the impact of oral anticoagulation (OAC) therapy on
long-term overall survival and clinically relevant bleedings in a large cohort of
hospitalised frail, oldest-old patients with AF.
Patients and methods
Prospective, observational, cohort study, evaluating patients consecutively hospitalized
for acute illnesses in our Geriatrics Unit (January 2013-July 2017). Participants
were divided in two groups, AF and sinus rhythm (SR). Besides recording demographic
characteristics and clinical history, comprehensive geriatric assessment (CGA) was
obtained.
Results
AF patients [1808/5093 (35.5%), 58.5% women] were older, with higher burden of comorbidity
than those with SR. At discharge, HAS-BLED [OR 0.77 (95%CI 0.67-0.90), cognitive impairment
[OR 0.92 (95%CI 0.90-0.95)], malnutrition [OR 0.74 (95%CI 0.57-0.97)] and CHA2DS2VASc
[OR 1.33 (95%CI 1.20-1.47)] emerged as significant independent predictors of anticoagulant
prescription. AF patients showed significantly reduced overall survival (OS) than
those with SR (11.4 vs 19.4 months, p<.001). However, anticoagulated AF patients (75.2%) had three-times longer OS than
those not anticoagulated (15.0 vs 5.6 months, p<.001), comparable to SR patients after adjustment for potential confounders [HR 1.04
(95%CI 0.99–1.10)]. ED readmittance risk for clinically relevant bleeding did not
differ between AF patients receiving or not anticoagulation [HR 1.04 (95%CI 0.76-1.14)]
Conclusion
anticoagulation therapy was associated with significant increase of long-term OS without
increased risk of clinically relevant bleeding. CGA resulted an useful tool in OAC
therapy decision-making.
Keywords
Abbreviations:
AF (atrial fibrillation), VKA (vitamin-K, antagonist), DOACs (direct-acting oral anticoagulants), ED (emergency department), CGA (comprehensive geriatric assessment), CIRS (Cumulative Illness Rating Scale), ADL (activities of daily living), IADL (instrumental activities of daily living), SPMSQ (Short Portable Mental Status Questionnaire), MNA (mini-nutritional assessment)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 04, 2021
Accepted:
January 20,
2021
Received in revised form:
January 15,
2021
Received:
August 7,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
