OBJECTIVES: To investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fi brillation (AF). BACKGROUND: AF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODS: The study was based on multicentric observational Slovak audit of atrial fi brillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTS: At hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSION: Warfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).

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Aims: Polypharmacy is one of the most typical features of geriatrics. Unreliable drug usage belongs to its risks, among others. One way of reducing this risk is to integrate more drugs into one tablet (polypill). Nowadays this could be done especially in cardiovascular medicine. Real world data from the health care provided in Slovakia, which would reflect the potential for switching from more tabs with one drug towards the polypill in seniors, are almost unknown. Methods: We used the "Slovak Audit of atrial FIbrillation Study" (SAFIS) data (3 706 patients, average age 80.5 years) and evaluated how frequently patients had the combination of an angiotensin converting enzyme inhibitor (ACEI) or an AT1-receptor for angiotensin II inhibitor (ARB) and a diuretic, an ACEI/ARB and a betablocker (BB), an ACEI/ARB and a statin or at least 3 out of these 4 drug groups at discharge. Results: The average number of recommended drugs was 9.1 at discharge. A diuretic, BB, statin or ACEI/ ARB was recommended in 68.9, 64.1, 31.9 and 52.4% of patients respectively. Simultaneous treatment with a diuretic and an ACEI/ARB, BB and an ACEI/ARB, statin and an ACEI/ARB was recommended in 37.9, 36.2, and 19.7% patients respectively. The frequency of these co-treatments was typically higher than 40% in 65-79 yrs. old, declining with age moderately, but staying above 20% even in the oldest (90 yrs. and older) for combinations of an ACEI/ARB with a diuretic or a BB. At least 3 drugs from the groups ACEI/ARB, BB, diuretics, statins were recommended in 38.6% of patients. Conclusion: The potential for the reduction of the number of daily used tablets with their integration in a polypill is really high in seniors. Fig. 1, Tab. 1, Ref. 20, on-line full text (Free, PDF) www.cardiologyletters.sk