Outcomes of anticoagulant prescribing for older patients with atrial fibrillation depends on disability level provided by long-term care insurance.

• The bleeding risk of oral anticoagulant use in very old patients remains controversial. • The outcomes of prescribing oral anticoagulants were observed in a hospital-based study. • Patients with disability had a higher incidence of stroke even though they took oral anticoagulants. • Disability level could be a surrogate marker for optimizing oral anticoagulant treatment. Background: Atrial fibrillation (AF) in patients aged ≥75 is one of the major risk factors for stroke, and prescription of oral anticoagulants (OACs) should be considered in these patients. We investigated the use of OAC' for patients certificated for long-term care (LTC) insurance, who have a high risk of bleeding among older patients. Methods and Results: From 1169 consecutive inpatients aged 75 or older who were admitted to the geriatric ward of The University of Tokyo Hospital between 2012 and 2017, we identified 175 patients (men 48%, mean age 85.5 years) who had AF during admission. The patients' background, prescription of OACs on discharge, and the level of LTC insurance were checked. Patients were followed up for 1 to 5 years. Major bleeding, stroke, and all-cause mortality were investigated as outcomes. Among patients with AF, 63.4% were taking OACs. In multivariate analysis, older age, low BMI and no history of stroke were significant factors for not prescribing OACs. Care level patients with OACs had a higher incidence of stroke than others. There was no difference, irrespective of OAC prescription and disability level, in incidence of major bleeding. Care level patients without OACs had higher mortality than others. Conclusions: These results suggest that older care level patients with AF may benefit less from OACs. [ABSTRACT FROM AUTHOR]