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The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study
- Source :
- Canadian Journal of Cardiology. 32:169-176
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Older adults are at increased risk of atrial fibrillation (AF), its thromboembolic complications, and bleeding. A significant percentage of octogenarians do not receive anticoagulation therapy. The objective of this study was to investigate the effect of thromboembolic risk, bleeding risk, and frailty on the anticoagulation status of octogenarians hospitalized with AF.A cross-sectional study was conducted in 682 hospitalized patients aged 80 years and older with AF or atrial flutter in Montreal, Québec. Consumption of warfarin or a new oral anticoagulant was documented. Medical record data were used to determine each patient's frailty status using the Clinical Frailty Scale (CFS) and to evaluate the risk of stroke (CHADS2 [Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack]) and bleeding (HAS-BLED [Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly ( 65 years) Drugs/alcohol concomitantly]). Univariable and multivariable logistic regression analyses were used to examine the effect of frailty status and the risk of stroke and bleeding on the probability of receiving anticoagulation therapy.Seventy percent of octogenarians with AF received anticoagulation therapy (n = 475). A high risk of stroke (CHADS2 = 3 compared with CHADS2 = 1, odds ratio [OR], 3.58; 95% confidence interval [CI], 1.09-11.77), and the absence of severe frailty (CFS7; OR, 3.41; 95% CI, 1.84-6.33) were independently associated with anticoagulant use in multivariable analyses. A high risk of bleeding (HAS-BLED score ≥ 3; OR, 0.33; 95% CI, 0.12-0.86) was associated with the absence of anticoagulation.Our study suggests a higher prevalence of appropriate anticoagulation among octogenarians with AF than reported in previous studies. Further work is needed to develop and disseminate tools to optimize the use of anticoagulants in this high-risk population.
- Subjects :
- Male
medicine.medical_specialty
Frail Elderly
Population
Administration, Oral
Hemorrhage
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Risk Factors
Thromboembolism
Internal medicine
Atrial Fibrillation
Humans
Medicine
030212 general & internal medicine
education
Blood Coagulation
Stroke
Aged
Retrospective Studies
Aged, 80 and over
education.field_of_study
Dose-Response Relationship, Drug
business.industry
Incidence
Quebec
Warfarin
Anticoagulants
Atrial fibrillation
Odds ratio
medicine.disease
Surgery
Cross-Sectional Studies
Female
Liver function
Cardiology and Cardiovascular Medicine
business
Risk assessment
Atrial flutter
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 0828282X
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....f81160ecffa0489e8b992cb868b7a494