Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation
Objectives: To assess clinicians’ prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. Methods: We performed a community-based retrospective cohort study of adults aged 65 years a...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-04-01
|
| Series: | Journal of Primary Care & Community Health |
| Online Access: | https://doi.org/10.1177/21501319241243005 |
| _version_ | 1797226804177534976 |
|---|---|
| author | Meaghan Costello Ericka E. Tung Karen M. Fischer Thomas M. Jaeger |
| author_facet | Meaghan Costello Ericka E. Tung Karen M. Fischer Thomas M. Jaeger |
| author_sort | Meaghan Costello |
| collection | DOAJ |
| description | Objectives: To assess clinicians’ prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. Methods: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. Results: A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001). Conclusions: A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation. |
| first_indexed | 2024-04-24T14:30:43Z |
| format | Article |
| id | doaj.art-11303cc69edf4e929670d83981740ac7 |
| institution | Directory Open Access Journal |
| issn | 2150-1327 |
| language | English |
| last_indexed | 2024-04-24T14:30:43Z |
| publishDate | 2024-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Primary Care & Community Health |
| spelling | doaj.art-11303cc69edf4e929670d83981740ac72024-04-03T02:03:38ZengSAGE PublishingJournal of Primary Care & Community Health2150-13272024-04-011510.1177/21501319241243005Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial FibrillationMeaghan Costello0Ericka E. Tung1Karen M. Fischer2Thomas M. Jaeger3The Ohio State University Wexner Medical Center, Columbus, OH, USAMayo Clinic, Rochester, MN, USAMayo Clinic, Rochester, MN, USAMayo Clinic, Rochester, MN, USAObjectives: To assess clinicians’ prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. Methods: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. Results: A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001). Conclusions: A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.https://doi.org/10.1177/21501319241243005 |
| spellingShingle | Meaghan Costello Ericka E. Tung Karen M. Fischer Thomas M. Jaeger Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation Journal of Primary Care & Community Health |
| title | Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation |
| title_full | Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation |
| title_fullStr | Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation |
| title_full_unstemmed | Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation |
| title_short | Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation |
| title_sort | anticoagulation patterns among community dwelling older adults with atrial fibrillation |
| url | https://doi.org/10.1177/21501319241243005 |
| work_keys_str_mv | AT meaghancostello anticoagulationpatternsamongcommunitydwellingolderadultswithatrialfibrillation AT erickaetung anticoagulationpatternsamongcommunitydwellingolderadultswithatrialfibrillation AT karenmfischer anticoagulationpatternsamongcommunitydwellingolderadultswithatrialfibrillation AT thomasmjaeger anticoagulationpatternsamongcommunitydwellingolderadultswithatrialfibrillation |