Impact of geriatric syndromes on anticoagulation prescription in older adults with atrial fibrillation

Abstract

Background

Atrial fibrillation (AF) is common in older adults. CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74, female) and HASBLED(Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) are the most established risk stratification tools in assessing suitability for anticoagulation in AF. However, there are no established screening tools for geriatric syndromes on anticoagulation risks in older adults.

Objective

This study examined the association of anticoagulation prescription with geriatric syndromes.

Methods

Older adults 65 years and above admitted to a tertiary hospital with atrial fibrillation and CHA2DS2-VASC score ≥ 2. Data on demographics, function (modified Barthel’s Index (MBI)), cognition (mini-cog), frailty (Edmonton Frail Scale (EFS) and FRAIL), geriatric syndromes (EFS), sarcopenia (SARC-F), HASBLED and CHA2DS2-VASC were collected.

Results

150 patients aged 65 and above (mean age 79.4 ± 7.1 years) with AF were recruited. 101 (67%) participants were anticoagulated, in univariate analysis comparing those who were anticoagulated with those who were not, age (OR 0.94; 95% CI 0.89−0.99), chronic kidney disease (OR 0.39; 95% CI 0.19−0.80), frailty (OR 0.77; 95% CI 0.60−0.98) and functional status by Barthel’s Index (OR 0.75; 95% CI 0.57−0.97) were significantly associated with anticoagulation prescription. In multivariate analysis, age (OR 0.93; 95% CI 0.88−0.99) and CKD (OR 0.35; 95% CI 0.16−0.76) remained significant. There was no significant difference in CHA2DS2-VASC, HASBLED, MBI or falls between the groups.

Conclusions

Age and CKD were significantly associated with anticoagulation prescription in patients with AF. Further studies on the impact of geriatric syndromes on anticoagulation prescription and outcomes in older adults are needed with specific guidelines for patients with geriatric syndromes and AF.

Keywords:

• Atrial fibrillation
• older adults
• anticoagulation
• frailty
• geriatric syndromes

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Li Feng Tan (LFT), Christopher Koo (CK) conceptualized this study. Wilson Goh, Shen Goy, CK did the data collection. LFT, Rodney Soh (RS), Lim Jiayi (LJY), Santhosh Seetharaman (SS), Reshma Merchant (RM) performed the data analysis and wrote up the study.

Data availability statement

Availability of data and materials: data is available upon request.

Ethics approval

Ethics approval and consent to participate – ethics approval for the study was obtained from the National Healthcare Group institutional review board. All authors consented to participated in this research.