Clinical ResearchThe Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study
Section snippets
Study design and population
A cross-sectional study was conducted in 682 patients aged 80 years and older with AF or AFL admitted to 3 academic hospitals in Montreal, Québec from January 1, 2012-December 31, 2013. Patients were identified for inclusion in the study by the medical archivist using the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes I48 for AF and AFL. Patients were excluded if they met any of the following criteria: age < 80 years, death during hospitalization,
Patient characteristics
A total of 1024 patients were randomly screened from a list of 1314 patients with AF or AFL who were hospitalized from January 1, 2012-December 30, 2013. Six hundred eighty-two patients met the inclusion criteria for the study (Fig. 1). Of these patients, 475 (69.6%) received anticoagulation therapy—373 (78.5%) were prescribed warfarin, 98 (20.6%) were prescribed a new oral anticoagulant agent (ie, dabigatran, rivaroxaban, or apixaban), 3 (0.6%) received a therapeutic dose of a
Discussion
A number of factors appear to influence the decision to prescribe anticoagulation therapy for octogenarians with AF or AFL. A high risk of thromboembolism was significantly associated with the decision to prescribe anticoagulation therapy in this study, regardless of age and bleeding risk, whereas a higher risk of bleeding led to abstention from prescribing anticoagulation therapy. Patients classified as nonfrail to only moderately frail were 3.5 times more likely to receive anticoagulation
Conclusions
Contemporary practice in 3 Canadian academic hospitals suggests that the decision to prescribe anticoagulation therapy to octogenarians with AF or AFL is influenced by a complex interplay of thromboembolic risk, bleeding risk, and frailty status. Rates of anticoagulation are clearly diminished among patients who are severely frail with advanced disability. Whether or not a 70% anticoagulation rate is reasonable remains to be determined by longitudinal studies that evaluate the thromboembolic
Acknowledgements
The authors thank Dr Fadi Massoud, Dr Judith Latour, Dr Isabelle Payot, Dr Thien Tuong Minh Vu, and Dr Marie-Jeanne Kergoat for their contribution to the development of the methodology of the Frailty, Stroke Risk and Bleeding Risk on Anticoagulation in the Elderly With Atrial Fibrillation (FRAIL-AF) study. We also express gratitude to biostatistician Martin Ladouceur for his statistical assistance.
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