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Impact of advanced age on management and prognosis in atrial fibrillation: insights from a population-based study in

Andreas Wolff1, Eduard Shantsila2, Gregory Y H Lip2

  • 1Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada.

Age and Ageing
|June 18, 2015
PubMed

Insights

Very elderly atrial fibrillation patients often miss oral anticoagulation (OAC) despite high stroke risk. Antiplatelet (AP) monotherapy increases stroke risk, highlighting the need for OAC in most elderly AF patients.

Area of Science:

  • Cardiology
  • Geriatrics
  • General Practice Research

Background:

  • Atrial fibrillation (AF) management in the very elderly (≥85 years) is understudied.
  • Optimal antithrombotic therapy selection is crucial for preventing stroke in this high-risk population.

Purpose of the Study:

  • To investigate antithrombotic therapy use and identify predictors of stroke and death in very elderly AF patients within a UK general practice cohort.

Main Methods:

  • Retrospective, observational cohort study with a 12-month follow-up.
  • Inclusion of 2,259 AF patients from 11 UK general practices, with 561 (24.8%) aged ≥85 years.
  • Analysis of antithrombotic therapy use by age group and predictors of stroke and death.

Main Results:

  • Very elderly AF patients (mean age 89) had a high mean CHA2DS2-VASc score (4.6).
  • Only 36% received oral anticoagulation (OAC), compared to 57% in the 75-84 years group; 49% received antiplatelet (AP) monotherapy.
  • Stroke risk was highest in the very elderly (5.2% annually), and AP monotherapy independently increased stroke risk (OR 2.45). OAC significantly reduced all-cause mortality (OR 0.59).

Conclusions:

  • Most very elderly AF patients are undertreated with OAC, despite elevated stroke risk.
  • Antiplatelet monotherapy is associated with increased stroke risk in this population.
  • Effective stroke prevention in AF necessitates OAC, irrespective of age, barring contraindications.
Abstract

Keywords:
ageantithrombotic therapyatrial fibrillationgeneral practiceolder peoplestroke

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