Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation

Area of Science:

• Geriatric Medicine
• Cardiology
• Pharmacology

Background:

• Atrial fibrillation or atrial flutter (AF/F) is a common arrhythmia in older adults, increasing stroke risk.
• Anticoagulation is a cornerstone therapy for stroke prevention in AF/F.
• Prescribing patterns for anticoagulation in elderly populations require ongoing assessment.

Purpose of the Study:

• To evaluate anticoagulation prescribing practices in older adults with nonvalvular AF/F.
• To identify factors associated with not receiving anticoagulation in this demographic.

Main Methods:

• Retrospective cohort study of 3832 adults aged 65+ with nonvalvular AF/F.
• Assessed oral anticoagulation utilization rates.
• Examined associations between anticoagulation use and comorbid conditions/geriatric syndromes.

Main Results:

• 70.3% of patients received oral anticoagulation (Vitamin K antagonist or direct-acting oral anticoagulant).
• Higher Elderly Risk Assessment (ERA) scores, dementia, and history of falls were associated with less frequent anticoagulation.
• Patients without anticoagulation had higher ERA scores and a greater incidence of dementia and falls.

Conclusions:

• A significant proportion of older adults with AF/F are not prescribed anticoagulation.
• Geriatric syndromes, including frailty, dementia, and falls, appear to influence anticoagulation decisions.
• Clinical practice may underutilize anticoagulation in vulnerable older adults with AF/F.