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Warfarin Treatment and All-Cause Mortality in Community-Dwelling Older Adults with Atrial Fibrillation: A Retrospective Observational Study
- Publication Year :
- 2016
-
Abstract
- Objectives To investigate the relationship between warfarin treatment and different strata of all-cause mortality risk assessed using the Multidimensional Prognostic Index (MPI) based on information collected using the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) in community-dwelling older adults with atrial fibrillation (AF). Design Retrospective observational study. Setting Older community-dwelling adults who underwent a SVaMA evaluation establishing accessibility to homecare services and nursing home admission from 2005 to 2013 in the Padova Health District, Italy. Participants Community-dwelling individuals with AF aged 65 and older (N = 1,827). Measurements Participants were classified as being at mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), or severe (MPI-SVaMA-3) risk of mortality using the MPI-SVaMA, a validated prognostic tool based on age, sex, comorbidity, cognitive status, mobility and functional disability, pressure sore risk, and social support. The association between warfarin treatment and mortality was tested using multivariate- and propensity score–adjusted Cox regression models, controlling for age, sex, all SVaMA domains, concomitant diseases, and drug treatments. Results Higher MPI-SVaMA scores were associated with lower rates of warfarin treatment and higher 3-year mortality. After adjustment for propensity score quintiles, warfarin treatment was significantly associated with lower 2-year mortality in individuals with MPI-SVaMA-1 (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.50–0.82), MPI-SVaMA-2 (HR = 0.68, 95% CI = 0.55–0.85), and MPI-SVaMA-3 (HR = 0.55, 95% CI = 0.44–0.67). Heterogeneity analyses confirmed that the effect of warfarin treatment was not different between MPI-SVaMA groups (P for heterogeneity = .48). Conclusion Community-dwelling older adults with AF benefitted from anticoagulation in terms of lower all-cause mortality over a mean follow-up of 2 years, regardless of poor health and functional condition. Although this benefit can be ascribed to the treatment, it may also reflect better overall care.
- Subjects :
- Male
Aging
medicine.medical_specialty
030204 cardiovascular system & hematology
Risk Assessment
Article
03 medical and health sciences
0302 clinical medicine
Risk Factors
Multidimensional prognostic index
Internal medicine
Cause of Death
Atrial Fibrillation
Risk of mortality
medicine
Humans
030212 general & internal medicine
Propensity Score
Geriatric Assessment
Aged
Retrospective Studies
Aged, 80 and over
Frailty
Proportional hazards model
business.industry
Hazard ratio
Warfarin
Anticoagulants
Retrospective cohort study
aging
all-cause mortality
atrial fibrillation
frailty
multidimensional prognostic index
warfarin
Geriatrics and Gerontology
All-cause mortality
medicine.disease
Prognosis
Comorbidity
Confidence interval
Aging, All-cause mortality, Atrial fibrillation, Frailty, Multidimensional prognostic index, Warfarin
Italy
Propensity score matching
Physical therapy
Female
Independent Living
business
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....38e1c06d9ee5f45eda3776d54d64b9d0