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Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial

Weijia Wang1, Darleen Lessard2, Catarina I Kiefe2

  • 1Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Journal of the American Geriatrics Society
|October 23, 2022
PubMed

Insights

In older patients with atrial fibrillation, anticoagulation increases bleeding and death risk for those with cognitive impairment. For frail patients, the risks and benefits of anticoagulation remain unclear.

Area of Science:

  • Gerontology
  • Cardiology
  • Neurology

Background:

  • Atrial fibrillation (AF) is common in older adults, often co-occurring with cognitive impairment and frailty.
  • The impact of anticoagulation on outcomes in this vulnerable population is not well understood.

Purpose of the Study:

  • To investigate whether the risks and benefits of anticoagulation in older patients with AF vary based on cognitive function and frailty status.

Main Methods:

  • 1244 older adults (age ≥65) with AF and CHADSVASC score ≥2 were assessed for cognitive function and frailty.
  • Outcomes (major bleeding, death) associated with anticoagulation were analyzed using propensity-adjusted hazard ratios, stratified by cognitive and frailty status.

Main Results:

  • Cognitively impaired individuals on anticoagulation had a higher risk of major bleeding or death (aHR=2.23).
  • No significant interaction was found between anticoagulation and frailty status for major bleeding or death (P=0.67).
  • Anticoagulation was associated with increased risk of major bleeding or death in cognitively impaired patients.

Conclusions:

  • Anticoagulation in older AF patients with cognitive impairment is linked to increased risks of major bleeding and death.
  • Further research is needed to clarify the role of anticoagulation in frail older adults with AF.
Abstract

Keywords:
anticoagulationatrial fibrillationbleedingcognitive functionfrailty

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