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Determinants of Antithrombotic Treatment for Atrial Fibrillation in Octogenarians: Results of the OCTOFA Study
Jacques Blacher1, Emmanuel Sorbets2, Dominique Guedj Meynier3
1Assistance Publique-Hôpitaux de Paris, Unité HTA, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu University Hospital, Université Paris Descartes, Place du Parvis Notre-Dame, 75004, Paris, France. jacques.blacher@aphp.fr.
Insights
Most cardiologists prescribe anticoagulants for elderly atrial fibrillation patients, with newer agents increasingly used. Key factors influencing prescriptions include stroke risk, bleeding risk, advanced age, and cognitive impairment.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Atrial fibrillation (AF) is a common arrhythmia in individuals over 80, significantly increasing stroke risk.
- Anticoagulant therapy is crucial for AF patients, with benefits outweighing bleeding risks, even in the elderly.
- Despite effective treatments like warfarin and newer oral anticoagulants, undertreatment remains a concern.
Purpose of the Study:
- To investigate the frequency of anticoagulant prescriptions in French octogenarian AF patients.
- To identify factors influencing anticoagulant prescribing habits among cardiologists for elderly AF patients.
Main Methods:
- The OCTOFA Study involved 89 cardiologists recruiting 738 eligible patients (age ≥ 80) with non-valvular AF.
- Data collected included patient demographics, comorbidities, and prescribed antithrombotic treatments.
- Statistical analysis identified determinants of anticoagulant prescription.
Main Results:
- Over 90% of patients received oral anticoagulant therapy (VKA or NOAC), with a small percentage on aspirin or no treatment.
- Patients on Vitamin K Antagonists (VKAs) were older and had more comorbidities, including heart failure and prior hemorrhage.
- Significant predictors for anticoagulant prescription included high CHA2DS2-VASc and HAS-BLED scores, age over 90, and cognitive impairment.
Conclusions:
- French private-practice cardiologists largely adhere to guidelines for prescribing anticoagulants in elderly AF patients.
- Non-vitamin K antagonist oral anticoagulants (NOACs) constitute a substantial portion of the prescribed anticoagulant treatments.
- Prescribing patterns reflect consideration of stroke and bleeding risk factors in this elderly population.
Background And Objective:
Atrial fibrillation, the most frequent form of arrhythmia, affects 5-15% individuals aged > 80 years. Stroke is a major risk for atrial fibrillation patients. The benefits of anticoagulant therapy clearly outweigh the risk of hemorrhage, even in the elderly. Despite the efficacy of warfarin, many eligible patients receive no prophylactic antithrombotic therapy. New generation oral anticoagulants compare favorably with vitamin K antagonists in the prevention of thromboembolic events and hemorrhage. These new agents are likely to influence the prescribing habits of anticoagulants in atrial fibrillation. The aim of this study to investigate both the frequency and the determining factors of anticoagulant prescriptions in AF patients aged ≥ 80 years and followed up by private-practice cardiologists in France.
Methods:
The OCTOFA (Atrial Fibrillation in Octogenarians) Study assessed the anticoagulant prescribing habits of cardiologists in France. The volunteer cardiologists recruited all consecutive patients fulilling the inclusion criteria.
Results:
Between June 2013 and September 2016, 89 cardiologists recruited 738 eligible patients: age ≥ 80 years, non-valvular atrial fibrillation, no other compelling indication for anticoagulation therapy, no recent acute coronary syndrome or stroke. Most (90.7%) patients were on oral anticoagulant therapy: vitamin K antagonist or non-vitamin K antagonist oral anticoagulants, low molecular weight heparin (1.4%), aspirin (5.7%), and no antithrombotic treatment (2.2%). Patients on vitamin K antagonists were older (p < 0.001), had lower renal function (p = 0.033), and had a more frequent history of myocardial infarction (p < 0.001), heart failure (p = 0.001), peripheral artery disease (p = 0.033), major hemorrhage (p = 0.025), and falls (p = 0.045). Four determining factors of anticoagulant prescriptions were statistically significant: high CHA2DS2-VASc score (p < 0.001), high HAS-BLED score (p < 0.001), age > 90 years (p = 0.001), and moderate/severe cognitive impairment (p = 0.002).
Conclusions:
Most private-practice cardiologists prescribe anticoagulant treatment according to current guidelines in elderly atrial fibrillation patients. Non-vitamin K antagonist oral anticoagulants represent a significant proportion of prescriptions.
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