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Published on: February 26, 2013
Outcomes and Disease Management in Patients With Atrial Fibrillation ≥80 Years: Data From a Consecutive 11-Year
Mustafa Yildirim1, Barbara Ruth Milles1, Hauke Hund1
1Department of Internal Medicine III, Cardiology University Hospital of Heidelberg Heidelberg Germany.
Insights
Elderly patients (≥80 years) with atrial fibrillation (AF) face higher risks. Oral anticoagulation (OAC) is crucial, but direct OACs may be preferable to vitamin K antagonists for this vulnerable group.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Increasing prevalence of atrial fibrillation (AF) in aging populations.
- Limited data on optimal oral anticoagulation (OAC) for patients aged 80 years and older.
- Need to evaluate OAC efficacy in elderly AF patients presenting to emergency departments.
Purpose of the Study:
- To compare the benefits of direct OACs versus vitamin K antagonists in patients aged 80 years and older with AF.
- To assess outcomes including all-cause mortality, stroke, and myocardial infarction in this demographic.
- To analyze the impact of OAC use on major bleeding events.
Main Methods:
- Retrospective analysis of the Heidelberg Registry of Atrial Fibrillation.
- Inclusion of patients with AF presenting to the University Hospital of Heidelberg (June 2009 - March 2020).
- Age-stratified analysis of outcomes and risk factors for predefined endpoints.
Main Results:
- Patients aged ≥80 years constituted 32.2% of AF cases and faced significantly higher risks for primary and secondary endpoints.
- OAC use was lower in patients ≥80 years (67.9%) compared to younger patients (70.5%).
- Vitamin K antagonist use was associated with a higher risk of stroke or major bleeding events, particularly when excluding reduced direct OAC doses.
Conclusions:
- Patients aged ≥80 years represent a vulnerable subgroup with AF.
- Evidence regarding optimal OAC therapy in this population remains conflicting.
- Further research is needed to establish definitive OAC guidelines for elderly AF patients.
Background:
As the population ages, atrial fibrillation (AF) prevalence increases, but data on optimal oral anticoagulation (OAC) in patients ≥80 years remain limited. This study tested whether direct OACs offer comparable benefits to vitamin K antagonists in patients ≥80 years with AF presenting to the emergency department.
Methods:
This single-center retrospective all-comer study used data from the Heidelberg Registry of Atrial Fibrillation, including patients with AF presenting to the emergency department of the University Hospital of Heidelberg from June 2009 until March 2020. Data were analyzed by age for outcomes and risk factors for predefined end points.
Results:
Patients ≥80 years comprised 32.2% of AF cases. Hazard ratios (HRs) for the primary end point (all-cause mortality, stroke, or myocardial infarction) and secondary end point (including major bleeding) were 3.09 (95% CI, 2.73-3.21) and 2.96 (95% CI, 2.73-3.21) for patients ≥80 years, compared with younger patients. Anticoagulation rates were slightly lower in patients ≥80 years (67.9% versus 70.5%, P=0.0070). OAC use, particularly the use of direct OACs, increased over time. Patients ≥80 years without OACs had higher HRs for primary (3.48 [95% CI, 3.07-3.94]) and secondary end points (3.23 [95% CI, 2.86-3.64]) compared with those with OACs. Vitamin K antagonist use was linked to higher HR for stroke or major bleeding events (HR, 1.25 [95% CI, 1.05-1.50]), rising to 1.64 (95% CI, 1.34-2.01) after excluding reduced direct OAC doses.
Conclusions:
Our data highlight patients ≥80 years as an important and vulnerable subpopulation of patients with AF, where evidence for optimal OAC therapy remains conflicting.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05995561.
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