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Introduction: Advancing patient engagement in clinical decision making is an important quality measure. Geriatric patients often rely on their support system to act as advocates in communicating with health care providers and making treatment decisions. Hypothesis: To assess the influence of patient companions (PC) during clinic visits on the use of invasive cardiac procedures in geriatric patients. Methods: Retrospective case-control study of clinic visits of patients >65 years old from 2012-2017 from a multispecialty geriatric clinic. Patients were defined to have PC if they were accompanied on > 50% of their visits (See Table). Invasive cardiac procedures were assessed by doubly robust forward and backward regression augmented propensity score adjusted multivariable regression, optimized by machine learning-generated neural networks. Results: 231 invasive procedures were identified. In 107 procedures (46.32%), patients were ≥ 80 years, 61% were female, 132 (57.14%) were Caucasians and 119 (51.52%) had a PC present. Patients with PC were more likely to have dementia (47.90% vs 16.96%, p<0.001) and less than a college education (42.4% vs 61.90%, p<0.013).In fully adjusted regression, they were significantly more likely to undergo peripheral angiogram and angioplasty (Odds Ratio (OR) 7.82, 95% Confidence Interval (CI) 1.93-31.70; p=0.004) and less likely to undergo left heart catheterization (OR 0.24, 95% CI 0.09-0.63; p=0.004). Patients with children as PC were less likely to elect for PPM/AICD (OR 0.25, 95CI 0.07 - 0.82; p=0.023). Conclusions: Our study demonstrates that the presence of PC affects geriatric patients electing to undergo invasive cardiac procedures and may influence the choice of invasive cardiac procedure in geriatric patients. As the options for cardiac interventions expands in older patients, innovative decision-support solutions are important in the optimal management of this population. [ABSTRACT FROM AUTHOR]

Background: Little to no data exist to guide treatment decision in patients with venous thromboembolism (VTE) and chronic liver disease., Objectives: To assess the effectiveness and safety of direct oral anticoagulants (DOACs)-individually and as a class-vs warfarin and between 2 DOACs in patients with acute VTE and chronic liver disease., Methods: We conducted a retrospective, US claims-based, propensity score-matched cohort study in adults with acute VTE and chronic liver disease who had newly initiated oral anticoagulants between 2011 and 2017. The primary outcome was a composite of hospitalization for recurrent VTE and hospitalization for major bleeding., Results: The cohorts included 2361 DOAC-warfarin, 895 apixaban-warfarin, 2161 rivaroxaban-warfarin, and 895 apixaban-rivaroxaban matched pairs. Lower risk of the primary outcome was seen with DOACs (hazard ratio [HR], 0.72; 95% CI, 0.61-0.85), apixaban (HR, 0.48; 95% CI, 0.35-0.66) or rivaroxaban (HR, 0.73; 95% CI, 0.61-0.88) vs warfarin but not apixaban-rivaroxaban (HR, 0.68; 95% CI, 0.43-1.08). The HRs of hospitalization for major bleeding were 0.69 (95% CI, 0.57-0.84) for DOAC-warfarin, 0.43 (95% CI, 0.30-0.63) for apixaban-warfarin, 0.72 (95% CI, 0.58-0.89) for rivaroxaban-warfarin, and 0.60 (95% CI, 0.35-1.06) for apixaban-rivaroxaban. Recurrent VTE risk was lower with apixaban (HR, 0.47; 95% CI, 0.26-0.86), but not DOACs (HR, 0.81; 95% CI, 0.59-1.12) or rivaroxaban vs warfarin (HR, 0.81; 95% CI, 0.57-1.14) or apixaban-rivaroxaban (HR, 0.92; 95% CI, 0.42-2.02)., Conclusion: While the magnitude of clinical benefit varied across individual DOACs, in adults with acute VTE and chronic liver disease, oral factor Xa inhibitors (as a class or individually) were associated with lower risk of recurrent VTE and major bleeding., (© 2023 The Authors.)